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Digitized  by  tine  Internet  Arciiive 

in  2007  with  funding  from 

IVIicrosoft  Corporation 


littp://www.arcliive.org/details/completeliandbookOOmasoiala 


A  COMPLETE  HANDBOOK 


FOR  THE 


SANITARY  TROOPS 


OF  THE 


U.  S.  ARMY  AND  NAVY 

AND 

NATIONAL  GUARD  AND  NAVAL  MILITIA 

BY 

CHARLES  FIELD  MASON 

Colonel   Medical   Corps,   U.   S.   Army 

FOURTH  EDITION,  REVISED 
Approved  by  the  Surgeon-Generals  of  the  Army  and  Navy 


PROFUSELY  ILLUSTRATED 


NEW  YORK 

WILLIAM  WOOD  AND  COMPANY 

MDCCCCXVIII 


Copyright,  191 7, 

BY 

WILLIAM  WOOD  AND  COMPANY 


M3e 


PREFACE  TO  THE  SECOND  EDITION 


In  presenting  the  second  edition  of  this  handbook  the  author 
desires  to  say  that  every  page  has  been  carefully  examined,  corrected, 
and  brought  up  to  date.  Many  of  the  parts  have  been  entirely 
rewritten  and  numerous  new  and  improved  illustrations  inserted. 
The  general  size,  plan,  and  scope  of  the  work  remain,  however, 
unchanged. 

Charles  Field  Mason. 

Washington,  January  31,  1909. 


PREFACE  TO  THE  FOURTH  EDITION 


In  this  edition  it  has  been  deemed  advisable  to  omit  the  part 
on  drill  regulations  for  sanitary  troops,  and  to  considerably  expand 
those  on  nursing,  and  those  on  pharmacy. 

The  appearance  of  a  revision  of  Army  Regulations  and  of  the 
Manual  Medical  Department  since  the  last  edition  of  this  book 
was  brought  out,  has  required  a  complete  rewriting  of  those 
parts,  while  all  the  chapters  have  been  carefully  revised,  corrected 
and  brought  up  to  date. 

Charles  Field  Mason. 

Washington,  December  i,  1916. 


TABLE  OF  CONTENTS 


PART  I 

SANITARY  TROOPS  IN  POST  AND  FIELD 

CHAPTER  I  PAGE 

The  Sanitary  Troops  in  Post 3 

Organization  of  the  sanitary  troops;  instruction;  promotion; 
duties ;  uniform ;  rules  for  hospital  administration. 

CHAPTER  n 

The  Sanitary  Soldier  in  War 12 

Administration  zones.  Objects  of  Medical  Department  Administra- 
tion. Duties  of  the  Medical  Department.  Personnel.  Titles  of  Med- 
ical officers.  Insignia.  Status  of  personnel.  Organization  in  war. 
The  service  of  the  interior.  Mobilization  camps.  Concentration; 
camps.  Camp  hospitals.  Hospital  trains.  Rest  stations.  Hospital 
ships.  The  theater  of  operations.  The  zone  of  the  advance.  Camp 
infirmaries.  The  ambulance  company.  The  field  hospital.  The  sta- 
tion for  slightly  wounded.  The  line  of  communications.  Base  hos- 
pital. Convalescent  camp.  Contagious  disease  hospital.  Trains, 
boats  and  ships.  Sanitary  squads.  Rest  stations.  Base  supply  depot. 
Advance  supply  depot.  Evacuation  hospital.  Evacuation  ambulance 
company.    Administration.     Resume. 

PART    II 

ANATOMY  AND  PHYSIOLOGY 

CHAPTER  I 

The  Skeleton  and  Joints 37 

Bone.  Cartilage.  Classification  of  bones.  The  vertebral  column. 
The  pelvis.  Joints.  Lower  extremity.  Thorax.  Upper  extremity. 
Skull.    Teeth. 

CHAPTER  II 

The  Muscles,  Cellular  Tissue,  and  the  Skin 48 

Muscles,  voluntary  and  involuntar>^  Action  of  muscles;  the  stemo- 
mastoid,  biceps,  diaphragm.  The  connective  or  cellular  tissue;  fat. 
The  skin  and  its  appendages.     Functions  of  the  skin. 

(v) 


vl  CONTENTS 

CHAPTER  III  PAGE 

The  Nervous  System  and  Special  Senses 53 

The  cerebro-spinal  system ;  brain,  spinal  cord,  and  nerves.  The  sym- 
pathetic system ;  ganglia  and  nerves.  The  special  senses ;  touch,  taste, 
smell,  hearing,  and  sight. 

CHAPTER  IV 

The  Digestive  Apparatus 61 

The  alimentary  principles  and  their  uses ;  albuminates,  fats,  starches 
and  sugars,  minerals.     The  alimentary  canal  and  digestion. 

CHAPTER  V 

The  Blood  and  the  Circulatory  System .■ 69 

The  lymphatic  system  and  its  functions.  The  blood ;  its  composition 
and  uses.  The  heart,  arteries,  capillaries,  and  veins.  The  circulation 
of  the  blood.  The  special  arteries  and  their  compression  points.  Spe- 
cial veins. 

CHAPTER  VI 

The  Respiratory  Apparatus 81 

The  larynx  and  vocal  cords.  The  trachea,  bronchi,  and  air  cells. 
The  lungs  and  pleura.  Respiration.  Air.  Ventilation.  Heat  regu- 
lation. 

CHAPTER  VII 
The  Excretory  Apparatus 85 

The  skin,  lungs,  and  bowels.  The  urinary  organs ;  the  kidneys, 
ureters,  bladder,  urethra.    The  urine.     The  suprarenal  glands. 


PART   III 

FIRST    AID 

CHAPTER  I 

Emergencies,  Contusions  and  Wounds 

How  to  act  in  emergencies ;  removal  of  clothing.  Contusions ; 
shock  and  its  treatment;  treatment  of  contusions.  Wounds,  incised, 
lacerated,  contused,  punctured,  poisoned,  gunshot.  Wound  infec- 
tion; septicemia  and  pyemia.  Treatment  of  wounds;  first-aid 
packets.  Wounds  of  the  skull,  of  the  chest,  of  the  abdomen,  of  the 
bladder.  Bites  of  insects,  of  tarantulas,  scorpions,  and  centipedes ; 
bites  of  snakes  of  rabid  animals.  Tetanus ;  anthrax.  Poisoned 
arrows,  etc. 


CONTENTS  vii 

CHAPTER  II  *  PAGE 

Hemorrhages gg 

Capillary  bleeding;  nose-bleeding,  bleeding  from  a  tooth  socket. 
Venous  bleeding.  Arterial  bleeding,  primary,  intermediate,  and  sec- 
ondary. Treatment  of  arterial  bleeding;  compression  with  the  fing- 
ers; with  the  tourniquet;  the  Spanish  windlass.  Bleeding  from 
special  arteries ;  in  the  upper  extremity,  the  lower  extremity,  the 
neck,  the  tongue,  the  lips,  the  face,  the  scalp.  Bleeding  from  the 
lungs,  the  stomach,  the  bowels. 

CHAPTER  III 

Dislocations  and  Sprains 103 

Dislocations,  definition  of;  symptoms,  diagnosis  from  fracture  and 
sprain;  treatment.  Special  dislocations;  shoulder,  lower  jaw,  fingers, 
knee-cap. 

Sprains;    definition;    symptoms,  treatment.     Sprained  ankle. 

CHAPTER  IV 
Fractures  .  .  .  • 108 

Fractures,  definition  of ;  compound,  simple,  comminuted,  compli- 
cated, impacted,  green-stick;  causes  of;  symptoms.  Treatment;  of 
simple  fractures;  setting,  splinting;  of  compound  fractures.  Healing 
of  fractures.  Splints.  Special  fractures;  of  the  skull,  spinal  column, 
ribs,  pelvis,  nasal  bones,  lower  jaw,  clavicle,  arm,  forearm,  meta- 
carpals, fingers,  thigh,  knee-cap,  leg,  foot. 

CHAPTER  V 

Foreign  Bodies  119 

In  the  eye.  In  the  ear.  In  the  nose ;  maggots  in  the  nose.  In  the 
throat.  In  the  air  passages.  In  the  stomach  and  intestines.  In  the 
skin. 

CHAPTER  VI 

The  Effects  of  Heat  and  the  Effects  of  Cold 122 

Heat-stroke.  Heat  exhaustion.  Burns  and  scalds ;  burns  from  cor- 
rosive acids  and  caustic  alkalies.  General  freezing.  Frost-bite. 
Chilblain. 

CHAPTER  VII 

Insensibility  and  Fits 126 

Fainting.  Concussion  and  compression  of  the  brain;  apoplexy. 
Lightning  stroke.  Electric  shock.  Acute  alcoholism.  Epilepsy. 
Bright's  disease  of  the  kidneys.     Opium  poisoning. 


viii  CONTENTS 

CHAPTER  VIII  PAGE 

Asphyxia 130 

Forms    of    asphyxia;    causes,    treatment.      Artificial    respiration; 
Scbaefer's  method,  Marshall  Hall's  method.    Drowning. 

CHAPTER  IX 

Poisoning 136 

Caustic  acids.     Caustic  alkalies.     General  management  of  cases  of  . 
poisoning.     Emetics,  antidotes,  combating  the  tendency  to  death. 

Special  poisons;  phenol    (carbolic  acid),  wood-alcohol,   food-pois- 
oning,  ptomaine   poisoning,    "knock-out    drops"    (chloral),    arsenic, 
corrosive  sublimate,  nitrate  of  silver,  phosphorus,  strychnine. 
Skin  poisons ;  poison-ivy,  poison  oak,  poison  sumach. 


PART   IV 

NURSING 

CHAPTER  I 
The  Ward  141 

Wards  in  post  hospitals ;  arrangements,  heating,  and  ventilation. 
Field  hospital  wards.  The  wardmaster.  Night  nurse.  Ward  clean- 
ing. 

CHAPTER  II 
Ward  Management  147 

The  new  patient.  Servdng  diets.  Administering  medicines.  The 
use  of  the  hypodermic.  Dying  patients.  Care  of  the  dead.  Autop- 
sies. 

CHAPTER  III 
Beds  and  Bed-making 152 

The  hospital  bed ;  its  preparation ;  changing  bed  linen.  Changing 
the  bed.  Changing  the  mattress.  Beds  for  operative  cases.  Fracture 
beds.    The  bed-rest.    Air  and  water  mattresses.     Bed  sores. 

CHAPTER  IV 

Baths  and  Bathing 157 

Purposes  for  which  baths  are  given.  Classification  of  baths. 
Sponge  baths.  Sedative  bath.  Hot-water  baths.  Hot-air  and  steam 
baths.  Cold  baths.  The  Brandt  System.  The  cold  sponge.  Bed 
tub-bath.  Alcohol  bath.  Bakes.  Electric  light  bath.  The  foot  bath. 
Sitz  bath. 


CONTENTS  ix 

CHAPTER  V  PAGE 

Enemata,  Irrigations,  Douches,  Catheterization,  etc 163 

Enemata,  classification  of.  Laxative  enema ;  nutrient  enema; 
medicinal  enema.     Irrigation. 

Urethral  injections.  Douches;  spinal;  nasal,  eye,  ear.  Catheteriza- 
tion.    Irrigation  of  the  bladder.     Catheterization  of  the  ureter. 

CHAPTER  VI 

External  Applications 169 

Hot-water  bags,  bottles,  etc.  Poultices.  Stupes.  Cold  compresses. 
The  ice  bag.  Ice-water  coil.  Mustard  plaster.  Liniments.  Dry 
cups.  Biers'  cups.  Blisters.  The  Paquelin  cautery.  Lunar  caustic. 
Blue  stone.     Nitric  acid. 

CHAPTER  VII 

Temperature,  Pulse,  and  Respiration 173 

Normal  and  subnormal  temperature.  Fever;  classifications  of 
fevers.  The  clinical  thermometer.  Charting  temperature.  The 
pulse;  varieties  of.  Respiration;  varieties  of.  Pulse,  respiration,  and 
temperature  ratio. 

CHAPTER  VIII 

Symptoms  and  Clinical  Record 179 

Symptoms;  subjective,  objective,  feigned;  the  attitude  and  ex- 
pression ;  mental  conditions ;  the  eyes ;  the  hearing ;  the  skin ;  the 
tongue,  mouth,  and  teeth ;  cough ;  the  appetite ;  vomiting ;  the  stools ; 
suppression,  retention,  and  incontinence  of  urine;  cough;  hiccough; 
pain;  hallucinations  and  delirium;  sleep.  Clinical  records;  history, 
treatment,  charts. 

CHAPTER  IX 
Bandaging  . 185 

The  triangular  bandage  and  its  application  to  various  parts  of  the 
body;  the  sUngs.  The  roller  bandage;  sizes;  method  of  rolling; 
rules  for  applying;  the  figure  of  eight;  the  spica;  the  knotted  turn; 
recurrent  of  the  head;  recurrent  of  a  stump;  application  to  various 
parts  of  the  body.  Flannel  and  rubber  bandages.  Fixed  bandages; 
plaster-of-Paris  bandages. 

CHAPTER  X 

Infection  and  Disinfection 200 

Definition.  Disinfectants;  dry  heat,  flowing  steam;  boiling  water, 
corrosive  sublimate,  phenol,  cresol,  quick-lime,  chlorinated  lime, 
formalin,  sulphur.  Prevention  of  spread  of  infectious  diseases.  Dis- 
infection of  sputum,  feces,  urine,  vessels,  infected  clothing,  bedding, 
beds,  rooms,  tentage. 


X  CONTENTS 

CHAPTER  XI  PAGE 

Instruments  and  Appliances 208 

Description  of  the  ordinary  instruments  and  appliances.  Special 
appliances  and  apparatus  of  the  medical  department  of  the  army; 
compressed  air  apparatus;  electric  batteries;  restraint  apparatus; 
steam  sterilizing  apparatus;  aspirating  case,  emergency  case.  Diag- 
nosis tags.  Field  equipment;  desk;  food  box;  commode  chest; 
acetylene  chest;  regimental  combat  equipment;  mess  chest. 


CHAPTER  XII 

The  Operating-room  and  Surgical  Nursing 242 

The  bacteria  of  surgical  infection.  Toxemia,  septicemia,  and  pyemia. 
Preparation  of  the  patient  for  operation ;  after-care ;  dressing. 

Preparation  in  the  operating-room.  The  sterilizer.  Sterilization  of 
instruments,  trays,  dressings,  sutures,  and  ligatures;  metal  and  glass 
syringes ;  rubber  goods,  web  catheters ;  water.  Normal  saline  solution. 
Drains.  Disinfection  of  the  hands  and  field  of  operation.  Care  of 
instruments,  etc.,  after  the  operation.     Operations  in  the  field. 


CHAPTER  XIII 
Nursing  in  the  Infectious  Diseases.    How  Infections  Spread.    Vac- 
cines AND  Antitoxins.    Typhoid  Vaccinations 252 

Typhoid  fever.  Dysentery.  Cholera.  Malaria.  Yellow  fever. 
Cerebro-spinal  meningitis.  Gonorrhea.  Chancroid.  Syphilis.  Pul- 
monary tuberculosis.  Pneumonia.  Influenza.  Follicular  tonsillitis. 
Diphtheria.  The  eruptive  fevers.  Mumps.  Erysipelas.  Wound 
infections.     Plague.     Typhus. 


PART    V 
MESS  MANAGEMENT  AND  COOKING 

CHAPTER  I 

Mess  Management   259 

The  mess;  sources  of  supply  in  post  and  field.     The  rations.     The 
diet. 

CHAPTER  II 

Cooking  .  .  .  266 

The  kitchen.     Eflfect  of  cooking  on  foods.     Boiling,  stewing,  soup- 
making,  roasting,  baking,  broiling,  frying.     Bread-making. 


CONTENTS  xi 

CHAPTER   III  PAGE 

Recipes    270 

•  Liquid  diets.     Semisolid  or  light  diets.     The  hospital  stores.    The 
rations.     Approximate  measures. 


PART    VI 

MATERIA  MEDICA  AND  THERAPEUTICS  AND  PHARMACY 

CHAPTER  I 

Materia  Medica  and  Therapeutics 287 

Drugs ;  active  principles ;  classification.  Administration  of  medi- 
cines;   dosage.     Army  and  Navy  supply  tables. 

CHAPTER  H 

Pharmacy    311 

Definitions.  Pharmaceutical  operations.  Official  and  non-official 
preparations.  Directions  for  making  emulsions,  pills,  ointments, 
powders,  and  suppositories.  Weights  and  measures.  Filling  prescrip- 
tions.    Incompatibility. 


PART    VII 

HYGIENE.     POST  AND  CAMP  SANITATION 

CHAPTER  I 

Water  337 

Daily  allowance.  Surface  and  ground  waters.  Purification  of 
water;  the  Lyster  sterilizing  bag;  the  Darnall  siphon-filter;  other 
processes.     Waterborne  diseases.     Collection  of  samples. 

CHAPTER  II 

Air  and  Ventilation   343 

Composition  of  air;  impurities.  Floor  space  and  cubic  air  space. 
Ventilation;  natural  and  mechanical.  Heating  by  stoves,  furnace, 
hot  water,  steam. 

CHAPTER  III 

The  Disposal  of  Wastes 349 

Disposal  in  posts;  by  pits,  pans,  water  carriage.  House  drainage. 
Bacterial  methods  for  purification  of  sewage.  Disposal  in  the  field; 
with  moving  commands;  construction  of  sinks;  in  fixed  camps;  gar- 
bage; cremations.     Sanitation  of  camps. 


xii  CONTENTS 

CHAPTER  IV  PAGE 

Disease  Prevention  355 

Typhoid,  malarial,  and  yellow  fevers,  and  their  transmission  by 
insects.  Diarrhea.  Dysenteries.  Eruptive  fevers;  vaccination  and 
vaccinia.    Cholera. 

CHAPTER  V 

Sanitation  in  the  Field 364 

Camp  sites.  Tents.  Water  supply.  Care  of  the  feet.  Charing. 
Lice. 

CHAPTER   VI 

Personal  Hygiene  367 

Cleanliness.  Dhobie  itch.  Teeth;  hair.  Clothing.  Venereal  dis- 
ease. Alcoholism.  Food  and  drink.  Exposure  to  the  sun.  Chilling 
at  night. 

PART   VIII 
RIDING,  PACKING,  AND  DRIVING 

CHAPTER  I 

Riding    37i 

The  equipment  of  the  horse.  Riding  without  and  with  the  saddle. 
Stable  duty. 

CHAPTER  II 

Pack  Saddle  and  Packing 389 

The  Medical  Department  pack  outfit;  to  use. 

CHAPTER  III 

Driving   393 

The  escort  wagon.  The  army  wagon.  The  ambulance.  Harness. 
Care  of  animals,  wagons,  and  harness  in  the  field. 


PART   IX 
ARMY    REGULATIONS 

Army  Reguations 413 

Medical  Department.  Hospital  Corps.  Garrison  Service.  Field 
Service.  General  Hospitals.  Service  of  Hospitals.  Hospital  Build- 
ings. Sick  Call.  Medical  Supplies.  Artificial  Limbs.  Manual  for 
the  Medical  Department.  Field  Hospitals  and  Ambulance  Compa- 
nies. Hospital  Corps  Detachments.  Analyses  of  Water.  Reports, 
Returns,  and  Records.  Hospitals  and  Medical  Attendance.  Service 
of  Hospitals,  general.  General  Hospitals.  Supplies  and  Materials. 
The  Sanitary  Service  in  War. 


CONTENTS  xiii 

PART   X 

CLERICAL   WORK  page 

Clerical  Work 45q 

List  of  reports  rendered  daily,  trimonthly,  monthly,  bimonthly, 
quarterly,  semiannually,  annually,  occasionally;  on  breaking  up  of 
hospital;  on  being  relieved  of  medical  property.     List  of  Records. 

PART   XI 
MINOR    SURGERY 

CHAPTER  I 

Anesthesia,  General  and  Local  467 

General  anesthesia;  preparation  for;  ether;  chloroform.  Anes- 
thesia in  the  tropics.  Local  anesthesia;  ethyl  chloride;  cocaine; 
eucaine ;  Schleich's  method.     Spinal  anesthesia. 

CHAPTER  n 

Assisting  at  Operations.     Minor  Operations 472 

Preparation  for  operation.     Handling  instruments.     Sponging. 
Incised  wounds;  suturing.    Contused  and  lacerated  wounds.     Boils. 
Carbuncles.    Felons.    Abscesses.     Gum-boils.     Ulcers.     Piles. 

CHAPTER   III 

Minor  Operations,  Continued 476 

Subcutaneous  saline  infusions.  Rectal  continuous  saline  infusion. 
Intra-venous  infusions;  salvarsan.  Antitoxin  injections.  Acupunc- 
ture. Aspiration.  Lumbar  puncture.  Mercury  injections  for  syphilis. 
Taking  blood  specimens.  Use  of  the  stomach  tube.  Forced  feeding. 
Introduction  of  metallic  catheters  and  sounds  into  the  bladder. 
Hernia  and  trusses.  Toothache  and  tooth  extraction.  Electric  bat- 
teries. 

CHAPTER  IV 

Adhesive  Plaster,  Straps  and  Strapping  485 

To  retain  splints.  Extension  in  fracture  of  the  thigh.  Strapping 
for  fracture  of  the  ribs.  Sayre's  strapping  for  fractured  clavicle. 
Strapping  a  swollen  testicle.  To  draw  wound  edges  together. 
Removal  of  adhesive  plaster. 


A  COMPLETE  HANDBOOK 

FOR  THE 

SANITARY  TROOPS 

OF  THE 

U.  S.  ARMY  AND  NAVY 

AND 

NATIONAL  GUARD  AND  NAVAL  MILITIA 


PART  I 

SANITABY   TROOPS   IN  POST   AND  FIELD 


CHAPTER  I 

THE  SANITARY  TROOPS  IN  POST 

The  Medical  Department  consists  of  one  Surgeon  General,  chief 
of  said  department,  a  Medical  Corps,  a  Medical  Reserve  Corps  tem- 
porarily, a  Dental  Corps,  a  Veterinary  Corps,  an  enlisted  force 
(Sanitary  Troops),  the  Nurse  Corps  and  contract  surgeons. 

The  enlisted  force  of  the  Medical  Department  consists  of  the  fol- 
lowing personnel :  Master  hospital  sergeants,  hospital  sergeants,  ser- 
geants (first-class),  sergeants,  corporals,  cooks,  horseshoers,  sad- 
dlers, farriers,  mechanics,  privates  (first-class),  and  privates.  Master 
hospital  sergeants  are  appointed  by  the  Secretary  of  War,  but  no 
person  can  be  appointed  master  hospital  sergeant  until  he  shall  have 
passed  a  satisfactory  examination  under  such  regulations  as  the 
Secretary  of  War  may  prescribe  before  a  board  of  one  or  more 
medical  ofiicers  as  to  his  qualifications  for  the  position,  including 
knowledge  of  pharmacy,  and  demonstrated  his  fitness  therefor  by 
service  of  not  less  than  twelve  months  as  hospital  sergeant  or  ser- 
geant, first  class,  Medical  Department,  or  as  sergeant,  first  class,  in 
the  Hospital  Corps;  and  no  person  may  'be  designated  for  such 
examination  except  by  written  authority  of  the  Surgeon  General. 
Original  enlistments  for  the  Medical  Department  are  made  in  the 
grade  of  private,  and  reenlistments  and  promotions  of  enlisted  men 
therein,  except  as  hereinbefore  prescribed,  and  transfers  thereto  from 
the  enlisted  force  of  the  line  or  other  staff  departments  and  corps 
of  the  Army  are  governed  by  such  regulations  as  the  Secretary  of 
War  may  prescribe.  The  total  number  of  enlisted  men  in  the  Medical 
Department  should  be  approximately  equal  to,  but  not  exceed, 
except  as  hereinafter  provided,  the  equivalent  of  five  per  centum 

(3) 


4  SANITARY  TROOPS  IN  POST  AND  FIELD 

of  the  total  enlisted  strength  of  the  Army  authorized  from  time  to 
time  by  law  but  in  time  of  actual  or  threatened  hostilities,  the  Secre- 
tary of  War  is  authorized  to  enlist  or  cause  to  be  enlisted  in  the 
Medical  Department  such  additional  number  of  men  as  the  service 
may  require.  The  number  of  enlisted  men  in  each  of  the  several 
grades  designated  below  may  not  exceed,  except  as  hereinafter  pro- 
vided, the  following  percentages  of  the  total  authorized  enlisted 
strength  of  the  Medical  Department,  to  wit:  Master  hospital  ser- 
geants, one-half  of  one  per  centum;  hospital  sergeants,  one-half  of 
one  per  centum;  sergeants,  first  class,  seven  per  centum;  sergeants, 
eleven  per  centum ;  corporals,  five  per  centum ;  cooks,  six  per  centum ; 
privates,  first  class,  forty-five  per  centum,  and  privates,  nine  per 
centum.  The  number  of  horseshoers,  saddlers,  farriers,  and  me- 
chanics may  not  exceed  one  to  each  authorized  ambulance  company 
or  like  organization. 

Enlisted  men  may  be  transferred  from  the  line  to  the  medical 
department  as  privates.  Married  men  are  not  accepted  as  recruits, 
nor  transferred  from  the  line  for  service  in  the  department.  Can- 
didates for  enlistment  should  apply  to  a  post  medical  officer  or  to  a 
recruiting  officer.  Applicants  who  have  graduated  in  pharmacy, 
or  who  have  had  training  as  nurses  in  civil  hospitals,  should  present 
certificates  of  their  special  qualifications.  Slight  physical  defects 
which,  under  existing  orders,  would  disqualify  for  the  line,  do  not 
disqualify  for  enlistment  in  the  department,  provided  they  are  not 
of  such  a  character  as  would  interfere  with  the  full  performance 
of  the  duties  of  a  sanitary  soldier  in  garrison  or  in  the  field.  If  a 
candidate  is  accepted  he  is  forwarded  to  a  company  or  detachment 
for  instruction  in;  i.  Discipline  and  the  duties  of  a  soldier;  2.  Care 
of  animals  and  equitation ;  3.  Bearer  drill  and  field  work ;  4.  Anat- 
omy and  physiology;  5.  First  aid  and  personal  and  camp  hygiene, 
including  the  sterilization  of  water  and  disinfection ;  6.  Nursing ; 
7.  Army  Regulations ;  8.  Cooking ;  9.  Materia  medica  and  pharmacy ; 
10.  Elementary  hygiene;  11.  Clerical  work.  All  privates  are  in- 
structed in  the  first  six  subjects,  and  those  who  show  special  aptitude 
take  the  complete  course. 

Instruction  in  the  first  three  subjects  is  continuous  throughout 
the  year;  the  other  subjects  are  included  in  the  regular  winter  course 
of  instruction  covering  a  period  of  thirty-four  weeks. 

Field  hospital  and  ambulance  companies  maintained  in  time  of 


THE  SANITARY  TROOPS  IN  POST  5 

peace  are  also  utilized  so  far  as  practicable  in  teaching  recruits  the 
work  of  the  sanitary  field  organizations.  The  course  of  study 
taught  recruits  while  with  these  organizations  is  supplemented  by 
practical  instruction  at  posts  and  in  the  field  after  their  assignment 
to  other  commands. 

The  course  for  noncommissioned  officers  comprises  the  following 
subjects:  Sanitary  administration,  pharmacy,  clerical  work,  minor 
surgery,  mess  management  and  Army  Regulations.  Privates,  first 
class,  and  privates  who  are  candidates  for  appointment  as  noncom- 
missioned officers  are  required  to  take  this  course ;  and  in  addition 
the  regular  course  prescribed  for  their  grades,  or  any  part  of  it,  if 
deemed  necessary  by  the  officer  in  charge  of  instruction. 

Privates,  first  class,  or  privates  who  have  shown  special  proficiency 
may  be  recommended  for  promotion  by  the  surgeon.  To  test  their 
capacity  for  performing  the  duties  of  a  noncommissioned  officer, 
they  may  be  first  detailed  as  lance  corporals.  Before  being  appointed 
sergeants  they  must  pass  an  examination  as  to  (i)  Physical  con- 
dition; (2)  character  and  habits,  especially  as  to  the  use  of  stimu- 
lants and  narcotics;  (3)  discipline  and  control  of  men;  (4)  knowl- 
edge of  regulations;  (5)  nursing;  (6)  dispensary  work ;  (7)  clerical 
work;  (8)  principles  of  cooking,  and  mess  management;  (9)  Hos- 
pital Corps  drill;  (10)  minor  surgery  and  first  aid,  including  extrac- 
tion of  teeth.  The  board  will  require  the  candidate  to  prepare  a 
full  set  of  papers  pertaining  to  the  medical  department,  and  to  drill 
a  detachment  sufficiently  to  demonstrate  his  thorough  knowledge 
of  the  drill  regulations. 

The  written  examination  will  embrace  the  following  subjects : 
(i)  Arithmetic;  (2)  materia  medica;  (3)  pharmacy;  (4)  care  of 
sick  and  ward  management;  (5)  minor  surgery  and  first  aid;  (6) 
elementary  hygiene.  Ten  questions  will  be  asked  in  each  subject. 
Proficiency  in  penmanship  and  orthography  will  be  estimated  from 
the  papers  submitted. 

Sergeants  who  have  served  a  year  as  such,  or  enlisted  men  of  the 
hospital  corps  who  served  as  hospital  stewards  of  volunteers  or  acted 
in  that  capacity  for  more  than  six  months  during  and  since  the 
Spanish-American  war,  may  be  appointed  sergeants,  first  class,  upon 
the  recommendation  of  the  Surgeon  General,  provided  they  have 
successfully  passed  a  more  extensive  and  detailed  examination  in 
the  above  subjects  than  is  required  for  promotion  to  the  grade  of 


6  SANITARY  TROOPS  IN  POST  AND  FIELD 

sergeant.  A  reexamination  before  his  first  reenlistment  may  not  be 
required  if  his  commanding  officer  and  the  department  surgeon  con- 
cur in  the  statement  that  the  candidate  has  performed  his  duties 
efficiently;  but  a  reexamination  is  called  for  before  a  second  re- 
enlistment,  after  which  no  fuither  examination  is  ordinarily 
required. 

Army  Regulations  provide,  for  at  least  one  noncommissioned 
officer  and  four  privates  at  each  permanent  military  post,  with  an 
additional  noncommissioned  officer  for  every  additional  four 
privates;  six  privates  when  the  garrison  is  two  hundred,  and  two 
privates  additional  for  every  additional  one  hundred  of  strength. 

The  uniform  for  ordinary  wear  is  the  same  as  that  of  the  line 
except  that  the  facings  are  of  maroon-colored  cloth  and  that  the 
caduceus  is  the  emblem  of  the  corps.  Privates,  first  class,  are  dis- 
tinguished from  privates  by  wearing  a  caduceus  upon  the  sleeves 
of  the  blouse  above  the  elbow.  For  duty  in  the  wards,  kitchen,  dis- 
pensary, and  operating-room  a  uniform  of  white  cotton  duck  is 
worn. 

The  duties  of  the  sanitary  troops  in  time  of  peace  are  chiefly  con- 
cerned with  the  care  of  the  sick,  sanitation  and  preparation  for  war ; 
that  they  are  many,  varied,  and  important  may  be  gathered  from  the 
scope  of  the  scheme  of  instruction  detailed  in  the  following  pages. 

The  peace  hospitals  of  the  army  are  of  three  classes,  post  hospitals, 
department  hospitals,  and  general  hospital^;  post  and  general  hos- 
pitals are  distinguished  from  each  other  by  the  fact  that  the  former 
usually  receive  only  the  sick  of  the  post  to  which  they  belong,  while 
the  general  hospitals  receive  the  sick  from  widely  separated  com- 
mands. Some  of  the  general  hospitals  are  of  a  special  nature,  such 
as  that  of  Fort  Bayard  for  the  treatment  of  tuberculosis,  and  the 
general  hospital  at  Hot  Springs,  Arkansas,  for  the  treatment  of  cases 
requiring  a  course  of  bathing. 

Department  hospitals  correspond  in  all  respects  to  general  hos- 
pitals except  that  they  are  under  the  control  of  the  Department 
Commander. 

The  duties  of  noncommissioned  officers  of  sanitary  troops  are 
to  maintain  discipline  in  hospitals  and  watch  over  their  general 
police;  to  supervise  the  duties  and  assist  in  the  instruction  of  the 
subordinate  personnel  in  hospital  and  in  the  field ;  to  look  after  and 
distribute  hospital  stores  and  supplies;    to  care  for  hospital  prop- 


THE  SANITARY  TROOPS  IN  POST  7 

erty ;  to  compound  medicines ;  to  prepare  reports  and  returns ;  and 
to  perform  such  other  duties  as  may,  by  proper  authority,  be 
required  of  them. 

The  senior  noncommissioned  officer  must  be  an  efficient  discipli- 
narian, expert  clerk,  accurate  arithmetician,  and  a  trustworthy  phar- 
macist, with  as  much  knowledge  of  materia  medica,  therapeutics, 
and  minor  surgery  as  will  enable  him  to  give  sound  advice  and  suit- 
able treatment  in  the  minor  ailments  and  accidents  which  in  civil 
life  are  dependent  on  the  resources  of  domestic  medicine  or  the 
knowledge  of  the  nearest  pharmacist;  in  addition,  he  must  have 
that  higher  knowledge,  for  use  in  the  wards,  which  enables  the  ex- 
perienced nurse  to  appreciate  the  condition  of  those  who  are 
seriously  ill,  that  their  improvement  may  be  fostered  and  all  harmful 
influences  excluded.  At  small  posts,  during  the  temporary  absence 
of  the  medical  officer,  the  unforeseen  casualties  and  even  many  of 
the  exigencies  of  military  life  impose  duties  upon  him  the  satisfac- 
tory performance  of  which  may  be  of  the  first  importance  to  the 
individuals  concerned. 

The  following  are  official  rules  for  the  interior  administration  of 
hospitals : 

(a)  GENERAL   RULES 

(i)  In  the  smaller  hospitals  the  senior  noncommissioned  officer,  under  the 
direction  of  the  surgeon,  is  in  immediate  charge  of  the  hospital  and  the 
Hospital  Corps  detachment.-  He  will  see  that  all  men  of  the  detachment  and 
all  patients  in  the  hospital  are  always  present  or  accounted  for.  He  will 
require  all  members  of  the  detachment  to  perform  their  duties  quietly  and 
treat  the  sick  with  gentleness  and  consideration.^ 

(2)  The  noncommissioned  officer  in  charge  of  public  property  will  keep  an 
accurate  account  of  the  same  and  its  place  of  distribution. 

(3)  Each  man  in  charge  of  a  department  of  the  hospital,  as  wardmaster, 
noncommissioned  officer  in  charge  of  mess,  etc.,  is  responsible  for  the  prop- 
erty used  in  his  department.  He  will  keep  a  list  of  the  same  and  will  by 
frequent  inventories  assure  himself  of  its  presence. 

(4)  All  public  property  in  the  possession  of  the  men  must  be  kept  in  good 
order  and  all  missing  or  damaged  articles  accounted  for. 

(5)  A  noncommissioned  officer  or  other  man,  upon  his  assignment  to  a 
department  of  the  hospital,  will  make  himself  familiar  with  the  special  orders 
governing  it,  and  all  must  familiarize  themselves  with  the  standing  orders 
of  the  hospital. 

1  In  the  larger  hospitals  it  may  be  necessary  to  distribute  these  duties  among  several 
noncommissioned  officers  as  determined  by  the  commanding  officer  of  the  hospital. 


8  SANITARY  TROOPS  IN  POST  AND  FIELD 

(6)  All  noncommissioned  officers  and  privates  of  the  detachment  will  be 
present  at  all  formations  unless  specially  excused. 

(7)  All  men  on  duty  in  the  kitchen  and  mess  room  will  arise  at  least  one 
hour  before  reveille;  all  other  members  of  the  detachment,  unless  specifically 
excused,  will  arise  at  or  before  first  call  for  reveille. 

(8)  Immediately  after  reveille  each  man  will  arrange  his  bed  and  personal 
belongings  in  a  neat  and  orderly  manner.  All  clean  underclothing  will  be 
neatly  folded  and  placed  in  the  lockers,  which  will  be  uniformly  packed;  other 
clothing  will  be  brushed  and  hung  in  the  lockers  or  in  a  specially  designated 
place.  Soiled  clothing  will  be  kept  in  the  barrack  bags.  Shoes  will  be 
polished  and  neatly  arranged  in  the  lockers  or  under  the  sides  of  the  beds. 

(9)  All  beds  will  be  overhauled  and  cleaned  each  week  and,  weather  per- 
mitting, the  bedding  and  mattresses,  together  with  the  other  clothing,  will  be 
well  shaken  and  hung  out  to  air  for  at  least  two  hours.  Mattress  covers  will 
be  changed  immediately  before  each  monthly  inspection  or  oftener  if  neces- 
sary.    Sheets  and  pollowcases  will  be  changed  at  least  once  each  week. 

(10)  A  card  bearing  the  name  of  the  soldier  will  be  attached  to  the  foot 
of  his  bed,  and  his  accouterments  will  be  hung,  neatly  and  uniformly  arranged, 
on  the  foot  end  iron  of  his  bunk. 

(11)  The  squad  room  will  always  be  kept  clean,  neat,  and  orderly. 

(12)  The  men  will  pay  the  utmost  attention  to  personal  cleanliness;  each 
will  bathe  at  least  once  weekly,  his  hair  must  be  kept  short,  and  his  face 
shaved,  or  beard  neatly  trimmed,  and  his  underclothing  frequently  changed. 
(See  Army  Regulations.) 

(13)  Members  of  the  detachment  will  wear  the  prescribed  uniform  at  all 
times  when  present  at  the  post.  While  on  fatigue  they  may  wear  the  fatigue 
dress.  While  on  duty  in  wards,  dispensary,  operating  room,  mess  room,  or 
kitchen,  they  will  wear  the  white  uniform. 

(14)  No  member  of  the  detachment  will  leave  the  hospital  bounds  except 
by  permission  of  proper  authority  or  in  case  of  emergency,  in  the  execution 
of  duty. 

(15)  Immediately  after  breakfast  the  hospital  will  be  thoroughly  policed 
in  every  department.  It  must  be  ready  for  inspection  at  the  hour  designated 
by  the  surgeon  and  always  be  kept  absolutely  clean. 

(16)  No  member  of  the  hospital  personnel  will  borrow  from  or  have 
financial  dealings  with  any  patient. 

(17)  When  necessary  a  noncommissioned  officer  in  charge  of  quarters  will 
be  detailed  daily  by  roster  from  noncommissioned  officers  on  duty  with  the 
detachment,  and  an  emergency  squad  will  always  be  designated. 

(18)  The  noncommissioned  officer  in  charge  of  quarters  will  make  an 
inspection  of  all  wards  and  quarters  at  such  times  as  the  surgeon  may  direct, 
will  report  all  unauthorized  absentees  to  the  noncommissioned  officer  in  charge 
of  the  detachment,  and  will  see  that  no  unauthorized  lights  are  burning.  In 
case  of  fire  he  will  give  the  alarm  and  proceed  as  ordered  in  fire  regulations. 
He  will  be  responsible  for  the  efficient  performance  of  the  watchman's  duties. 

(19)  The  night  watchman,  when  one  is  necessary,  will  be  under  the  im- 
mediate orders  of  the  noncommissioned  officer  in  charge  of  quarters.    He 


THE  SANITARY  TROOPS  IN  POST  9 

will  patrol  the  hospital  grounds  at  least  once  every  three  hours  and  will  be 
constantly  on  the  alert  for  fires,  lights,  and  unauthorized  persons  in  or  about 
the  hospital.  He  will  at  once  report  to  the  noncommissioned  officer  indicated 
all  unusual  occurrences  and  violations  of  existing  orders  which  come  under 
his  observation. 

(b)  WARD  RULES 

(i)  The  wardmaster  of  each  ward  is  directly  responsible  to  the  ward 
surgeon.  He  is  in  charge  of  his  ward  and  the  enlisted  assistants  and  patients 
in  it,  and  will  be  obeyed  and  respected  accordingly. 

(2)  The  wardmaster  is  responsible  for  the  cleanliness  and  order  of  his 
ward,  for  the  public  property  therein,  and  for  the  effects  of  his  patients  until 
they  have  been  turned  over  to  the  proper  custodian.  He  is  responsible  for 
the  prompt  delivery  of  prescriptions  to  the  dispensary,  of  medicines  to  his 
ward,  and  of  the  diet  orders  to  the  hospital  office. 

(3)  In  wards  to  which  members  of  the  Nurse  Corps  are  not  assigned  the 
wardmaster  is  responsible  for  the  administration  of  medicines  and  other 
treatment  prescribed,  the  keeping  of  records,  and  all  other  duties  that  may 
be  assigned  to  him  by  the  ward  officer. 

(4)  Phenol,  bichloride  of  mercury,  other  active  poisons,  alcohol,  and 
alcoholic  liquors,  when  necessarily  on  hand  in  the  ward,  will  be  kept  under 
lock  and  key  and  every  precaution  taken  to  prevent  their  improper  use. 

(5)  On  the  death  of  a  patient  the  wardmaster  will  notify  the  ward  sur- 
geon, or  in  his  absence  the  medical  officer  of  the  day.  He  will  not  remove 
the  body  from  the  ward  until  after  it  has  been  examined  by  a  medical  officer, 

(6)  The  wardmaster  will  see  that  patients  are  acquainted  with  the  ward 
rules. 

(7)  Before  leaving  the  ward  at  the  end  of  his  daily  tour  of  duty,  the 
wardmaster  will  turn  over  to  his  relief  all  orders  of  the  ward  surgeon, 
accompanied  by  such  explanation  and  instruction  as  may  be  necessary. 

(8)  Upon  reaching  the  ward,  patients  will  be  promptly  bathed,  clothed  in 
clean  hospital  clothing,  and  put  to  bed,  unless  their  condition  indicates  other- 
wise or  a  specific  order  forbids. 

(9)  Money  and  valuables  found  on  patients  will  be  disposed  of  as  pre- 
scribed in  Manual  Medical  Department.  The  commanding  officer  will  not 
be  responsible  for  money  or  valuables  of  patients  not  turned  over  for 
deposit  in  the  hospital  safe. 

(10)  A  clinical  record  will  be  carefully  kept  for  each  patient.  Upon  final 
disposition  of  the  case  this  record  will  be  completed  and  signed  by  the  ward 
surgeon  and  turned  in  to  the  record  office. 

(11)  No  information  regarding  the  diseases  or  condition  of  patients  under 
treatment  will  be  given  to  anyone  except  those  authorized  under  the  regula- 
tions to  receive  it. 

(12)  Visitors  will  be  allowed  to  see  friends  in  the  ward  at  a  specified  time, 
when  their  presence  will  in  no  way  disturb  other  patients ;  but  female  visitors 
will  not  be  permitted  in  the  wards  except  when  cases  are  serious,  and  then 
only  by  special  permission  of  the  ward  surgeon. 


10  SANITARY  TROOPS  IN  POST  AND  FIELD 

(13)  Bed  linen  will  be  changed  on  occupied  beds  at  least  twice  weekly,  and 
oftener  if  necessary  to  insure  cleanliness.  Whenever  a  bed  is  to  be  occupied 
by  a  new  patient  clean  linen  will  be  furnished.  All  bedding  and  clothing  used 
by  infectious  cases  will  be  promptly  disinfected  when  removed  from  the  beds. 
Patients  will  not  occupy  their  beds  when  dressed  in  other  than  hospital 
clothing. 

(14)  Loud  noises,  boisterous  actions,  the  use  of  profane  language,  and 
gambling  are  forbidden  in  the  wards,  and  no  food,  intoxicants,  or  other 
articles  of  food  or  drink,  except  as  prescribed  or  authorized,  will  be  brought 
into  the  wards. 

(15)  Patients  are  forbidden  to  use  towels,  basins,  toilet  articles,  eating 
utensils,  or  articles  of  clothing  pertaining  to  another  patient. 

ADMISSION   AND  DISTRPBUTION    OF    PATIENTS 

Upon  his  admission  to  hospital  a  patient  will  first  be  taken  to 
the  receiving  ward,  if  there  is  one,  or  to  the  office,  where  his  register 
card  will  be  filled  in  so  far  as  the  data  are  available  at  the  time,  the 
treatment  ward  to  which  he  is  assigned  being  noted  on  the  back 
thereof.  There  will  also  be  entered  on  a  clinical  record  brief  (Form 
550)  the  patient's  name,  rank,  organization,  etc.,  the  diagnosis  on 
the  transfer  card,  if  one  has  been  received,  and  the  designation  of 
the  ward  to  which  he  is  assigned.  This  form  will  accompany  the 
patient  to  the  ward  and  will  be  the  wardmaster's  authority  for  his 
admission  thereto. 

Upon,  reaching  the  treatment  ward  the  patient  will  be  promptly 
stripped,  bathed,  clothed  in  clean  hospital  clothing  and  put  to  bed, 
unless  his  condition  indicates  otherwise  or  a  specific  order  forbids. 

The  treatment  sheet  and  the  other  clinical  record  sheets  if  required 
will  be  begun  immediately  upon  the  patient's  admission. 

The  daily  routine  of  the  service  of  a  post  hospital  begins  at 
reveille,  when,  after  roll  call,  the  wards  are  tidied  up  and  breakfast 
is  served  and  cleared  away  before  sick-call  is  sounded.  Promptly  on 
this  call  a  noncommissioned  officer  from  each  company  brings  his 
sick  to  the  place  designated  for  their  inspection ;  usually  the  hospital 
or  a  dispensary.  A  medical  officer  examines  each  man,  indicating  in 
the  company  sick  report  book  those  who 'are  to  be  treated  in  hospital 
and  those  who  are  to  be  excused  from  duty  or  portions  thereof  as 
sick  in  quarters,  etc.  Morning  reports  are  then  sent  to  the  ad- 
jutant's office  for  the  information  of  the  commanding  officer.  Pre- 
scriptions for  those  in  quarters  are  now  filled,  and  the  register  of 
sick  and  wounded  is  brought  up  to  date  by  the  careful  entry  of  the 
morning's  changes.     After  breakfast  the  wards  are  visited  and  the 


THE  SANITARY  TROOPS  IN  POST  11 

prescription  and  diet  orders  recorded.  After  this  the  kitchen, 
dining-room,  and  other  parts  of  the  hospital  are  inspected,  and  the 
regulation  visit  is  at  an  end.  Emergency  calls  bring  the  medical 
officer  to  the  hospital  at  any  hour  and  generally,  when  serious  cases 
are  on  hand,  he  may  be  expected  before  retreat  or  tattoo.  After  the 
morning  visit  he  attends  to  his  patients  in  the  families  of  officers, 
married  soldiers,  laundresses,  and  other  attaches  of  the  garrison,  and 
his  prescriptions  reach  the  dispensary  from  time  to  time  during  the 
forenoon.  By  the  time  these  are  filled  the  senior  noncommissioned 
officer  has  posted  the  records,  supplied  the  wards  with  needful 
articles  of  bedding,  etc.,  given  directions  for  the  diet  of  the  day,  and 
provided  the  required  supplies  from  his  subsistence  stores  and  special 
diet  fund  and  hospital  fund  purchases.  The  afternoon  may  be  de- 
voted to  instruction,  exercises,  or  amusements,  in  the  absence  of 
special  call  for  its  occupation  otherwise,  and  the  evening  to  study, 
or,  at  certain  periods,  to  the  preparation  of  official  reports  and 
papers.  The  studies  of  the  sanitary  soldiers  are  naturally  such  as 
will  fit  them  to  act  intelligently  in  all  matters  relating  to  the  manage- 
ment of  the  hospital  and  the  sick  and  wounded.  Every  medical 
officer  supervises  the  instruction  of  his  men  and  the  higher  education 
of  his  noncommissioned  officers ;  the  latter  guide  and  perform 
similar  offices  to  those  who  serve  under  them.  The  medical  officer 
is  required  by  regulations  to  devote  at  least  five  hours  each  week 
to  instructing  the  men  of  the  corps  in  their  various  duties.  These 
duties  will  eventually  lead  every  capable  member  of  the  corps  to  the 
position  of  a  noncommissioned  officer;  but  besides  this  personal 
influence  they  serve  a  higher  end  by  preparing  the  corps  for  sudden 
expansion  in  time  of  war.  When  every  sergeant  is  qualified  to 
undertake  the  duties  of  the  next  higher  grade,  and  every  private 
qualified  for  the  position  of  sergeant,  the  expansion  of  the  command 
can  be  effected  by  merely  recruiting  for  the  lowest  grade. 

The  senior  medical  officer  is  responsible  for  the  timely  and  accu- 
rate rendition  of  the  reports  and  papers  required  in  the  service  of 
post  hospital ;  but  the  work,  except  in  the  case  of  special  and  profes- 
sional reports,  is  usually  performed  by  enlisted  men,  to  whom  the 
clerical  work  has  been  assigned.  For  all  routine  reports  blank  forms 
are  provided  by  the  War  Department,  and  full  instructions  are 
printed  on  each  of  these  to  insure  accuracy,  the  said  instructions 
having  the  force  of  Army  Regulations. 


CHAPTER  II 

THE  SANITARY   SOLDIER    IN    WAR 

The  duties  of  the  sanitary  soldier  in  war  are  even  more  varied 
and  important  than  in  time  of  peace  and  are  apt  to  be  more  clearly- 
defined.  Thus  some  men  will  be  assigned  as  litter-bearers,  others  as 
nurses,  orderlies,  cooks,  operating-room  assistants,  etc.  It  is  neces- 
sary that  even  privates  should  understand  something  of  the  field 
organization  of  the  medical  department. 

ADMINISTRATIVE   ZONES 

In  time  of  war  the  activities  of  the  military  establishment 
embrace : 

(i)  The  service  of  the  interior. 

(2)  The  service  of  the  theater  of  operations. 

The  service  of  the  interior  is  carried  on  by : 

(i)   Department  commanders. 

(2)  Bureau  chiefs,  having  for  this  purpose  general  depots  of 
supply,  general  hospitals,  arsenals,  etc. 

(a)  The  service  of  the  theater  of  operations  is  carried  on  by  the 
commander  of  the  field  forces.  The  theater  of  operations  is  divided 
into  two  zones : 

(i)   The  zone  of  the  line  of  communications. 
(2)  The  zone  of  the  advance. 

(b)  The  service  of  the  interior  functions  both  in  peace  and  in 
war;   that  of  the  theater  of  operations  in  war  only. 

OBJECTS    OF    MEDICAL  DEPARTMENT    ADMINISTRATION 

The  objects  of  Medical  Department  administration  in  war  are: 
(a)  The  preservation  of  the  strength  of  the  Army  in  the  field  by 
(i)  the  necessary  sanitary  measures;  (2)  the  retention  of  effectives 
at  the  front,  and  the  movement  of  noneffectives  to  the  rear  without 
obstructing  military  operations;  and  (3)  the  prompt  succor  of 
wounded  on  the  battlefield  and  their  removal  to  the  rear,  thus  pre- 

(12) 


THE  SANITARY  SOLDIER  IN  WAR  13 

venting  the  unnecessary  withdrawal  of  combatants  from  the  firing 
line  to  accompany  the  wounded,  and  promoting  the  general  morale 
of  the  troops. 

(b)  The  care  and  treatment  of  the  sick  and  injured  in  the  zone  of 
the  advance,  on  the  line  of  communications,  and  in  home  territory. 

DUTIES    OF   THE    MEDICAL   DEPARTMENT 

The  Medical  Department  is  charged  with  the  administration  of 
the  sanitary  service.     Specifically,  its  duties  are : 

(a)  The  initiation  of  sanitary  measures  to  insure  the  health  of 
the  troops. 

(b)  The  direction  and  execution  of  all  measures  of  public  health 
among  the  inhabitants  of  occupied  territory. 

(c)  The  care  of  the  sick  and  wounded  on  the  march,  in  camp,  on 
the  battlefield,  ^md  after  removal  therefrom. 

(d)  The  methodical  disposition  of  the  sick  and  wounded. 

(e)  The  transportation  of  the  sick  and  wounded. 

(/)  The  establishment  of  hospitals  and  other  formations  necessary 
for  the  care  of  the  sick  and  wounded. 

(g)  The  supply  of  sanitary  material  necessary  for  the  health  of 
troops  and  for  the  care  of  the  sick  and  wounded. 

(h)  The  preparation  and  preservation  of  individual  records  of 
sickness  and  injury,  in  order  that  claims  may  be  adjudicated  with 
justice  to  the  Government  and  to  the  individual. 

PERSONNEL  OF  THE    SANITARY    SERVICE 

General  Enumeration 

In  time  of  war  the  sanitary  service  includes  : 

(i)  All  persons  serving  in  or  employed  by  the  Medical  Depart- 
ment, including  officers  and  men  temporarily  or  permanently  detailed 
therein. 

(2)  Members  of  the  American  National  Red  Cross  assigned  to 
duty  with  the  Medical  Department  by  competent  authority. 

(3)  Individuals  whose  voluntary  service  with  the  Medical  Depart' 
ment  is  duly  authorized. 

(a)  The  personnel  of  the  Medical  Department  and  all  other  per- 
sons assigned  to  duty  with  that  department  are  collectively  called 
sanitary  troops. 


14  SANITARY  TROOPS  IN  POST  AND  FIELD 

The  following  persons  serve  in  or  are  employed  by  the  Medical 
Department ; 

(i)  Medical  officers  of  the  Regular  Army  (including  officers  of 
the  Medical  Reserve  Corps),  of  the  Organized  Militia  called  into  the 
service  of  the  United  States,  and  of  the  Volunteer  Army. 

(2)  Physicians  under  contract. 

(3)  Members  of  the  Dental  Corps. 

(4)  Members  of  the  Hospital  Corps. 

(5)  Members  of  the  Nurse  Corps. 

(6)  Officers  and  soldiers  of  the  line  or  staff  detailed  for  duty  with 
the  Medical  Department. 

(7)  Civilians  employed  by  the  Medical  Department. 

TITLES   OF   MEDICAL   OFFICERS 

The  title  of  the  senior  medical  officer  on  the  staff  of  the  com- 
mander of  a  field  army  is  "  chief  surgeon  "  ;  of  a  line  of  communica- 
tions, "surgeon,  base  group";  of  a  division,  "division  surgeon"; 
of  a  brigade  operating  independently,  "  brigade  surgeon  " ;  of  a 
detachment,  regiment,  or  smaller  command,  "  the  surgeon  " ;  of  a 
field  hospital  or  other  sanitary  formation,  and  of  an  ambulance  com- 
pany or  detachment  thereof,  "  commanding  officer." 

INSIGNIA  OF  SANITARY  PERSONNEL,  FORMATIONS,  AND  MATERIAL 

(See  Rules  of  Land  Warfare.) 

In  campaign,  all  persons  belonging  to  the  sanitary  service  and 
chaplains  attached  to  the  Army  wear  on  the  left  arm  a  brassard 
bearing  a  red  cross  on  a  white  ground,  the  emblem  of  the  sanitary 
service  of  armies.  This  brassard  is  issued  and  stamped  with  a  num- 
ber by  competent  authority,  and  in  case  of  persons  who  do  not  have 
military  uniforms  it  is  accompanied  by  a  certificate  of  identity. 

Brassards  will  be  issued  to  the  uniformed  personnel  of  the  sani- 
tary service  and  to  chaplains  by  the  senior  medical  officer  of  the 
organization  with  which  they  are  on  duty.  To  other  individuals 
entitled  thereto  under  the  provisions  of  the  Geneva  convention 
brassards  and  certificates  of  identity  (Form  61)  will  be  issued  by 
the  division  surgeon,  surgeon,  base  group,  the  department  surgeon, 
or  the  Surgeon  General,  as  the  case  may  require.  The  certificate  of 
identity  will  bear  the'  same  number  as  the  brassard. 


THE  SANITARY  SOLDIER  IN  WAR  15 

The  person  to  whom  a  certificate  of  identity  is  issiied  will  retain 
it  in  his  personal  possession  and  exhibit  it  when  called  upon  by  com- 
petent authority  to  do  so.  Care  will  be  exercised  to  prevent  the 
certificate  of  identity  or  its  container  from  coming  into  the  hands 
of  another  person.  The  loss  of  a  brassard  or  of  a  certificate  will  be 
investigated  and  reported  by  the  immediate  commander  to  the  office 
which  issued  the  lost  article. 

All  sanitary  formations  display  during  daylight  (reveille  to  re- 
treat) the  Red  Cross  flag  accompanied  by  the  National  flag.  If  a 
sanitary  formation  falls  into  the  hands  of  the  enemy  it  displays  while 
in  such  situation  the  Red  Cross  flag  only.  At  night  the  positions  of 
sanitary  formations  are  marked  by  green  lanterns  —  a  camp  infirm- 
ary by  one  green  lantern ;  a  field  hospital  by  two  green  lanterns,  one 
above  the  other ;  and  an  ambulance  company  or  its  dressing  station 
by  one  green  lantern  above  one  white  lantern. 

All  materiel  pertaining  to  the  sanitary  servicers  also  marked  with 
the  Red  Cross  emblem,  a  red  cross  on  a  white  ground. 

STATUS  OF   SANITARY    PERSONNEL   AND    MATERIAL 

All  the  personnel  of  the  sanitary  troops  and  armed  detachments 
or  sentinels  .ordered  by  competent  authority  to  guard  sanitary  for- 
mations are  respected  and  protected  under  all  circumstances.  If 
they  fall  into  the  hands  of  the  enemy,  they  do  not  become  prisoners 
of  war  but  are  disposed  of  as  provided  in  Article  12  of  the  Geneva 
convention,  1906.  In  order  to  obtain  this  protection,  the  command- 
ing officer  of  every  sanitary  formation  should  require  of  his  subordi- 
nates a  strict  observance  of  the  terms  of  the  Geneva  convention. 

ORGANIZATION    OF   THE   MEDICAL  DEPARTMENT   IN    WAR 

The  following  table  gives  an  outline  of  the  organization  of  the 
Medical  Department  in  war : 


16  SANITARY  TROOPS  IN  POST  AND  FIELD 


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THE  SANITARY  SOLDIER  IN  WAR  17 


THE  SERVICE  OF  THE  INTERIOR 

MOBILIZATION    CAMPS 
(See  Army  Regulations:  Organized  Militia) 

The  places  of  assembly  for  Volunteers  and  for  the  Organized 
Militia  of  a  State,  Territory,  or  the  District  of  Columbia  when  called 
into  the  service  of  the  United  States  are  known  as  mobilization 
camps. 

CONCENTRATION    CAMPS 
(See  F.  S.  R. :  Service  of  the  Interior.) 

The  places  which  are  selected  by  the  War  Department,  when  war 
is  imminent  or  has  been  declared,  for  the  assembly  of  troops  for 
joint  operations  or  for  embarkation,  are  known  as  concentration 
camps. 

CAMP    HOSPITALS 

A  camp  hospital  is  an  immobile  unit  organized  and  equipped  for 
use  in  camps  where  the  care  of  the  sick  would  otherwise  result  in 
the  immobilization  of  field  hospitals  or  other  sanitary  formations 
pertaining  to  organizations. 

HOSPITAL   TRAINS    AND   TRAINS    FOR   PATIENTS 

Hospital  trains  are  Medical  Department  organizations  and  will 
be  provided  by  the  War  Department  when  required  for  the  trans- 
portation of  the  sick  and  wounded.  In  cases  of  emergency  when 
hospital  trains  are  not  available  ordinary  trains  for  patients  will  be 
provided  for  the  temporary  use  of  the  Medical  Department. 

A  hospital  train  made  up  of  lo  cars,  of  which  8  are  for  patients 
(capacity  200),  is  allowed,  in  accordance  with  Tables  of  Organiza- 
tion, a  personnel  of  3  medical  officers  (captains  or  lieutenants)  ;  3 
noncommissioned  officers  (i  sergeant  first  class,  2  sergeants)  ;  2  act- 
ing cooks;  22  privates  first  class  and  privates  (20  nurses,  2 
orderlies). 

REST    STATIONS 

Rest  stations  will  be  organized  at  points  on  the  railway  lines  where 
attention  can  best  be  given  to  sick  and  wounded  en  route.     So  far 
2 


18  SANITARY  TROOPS  IN  POST  AND  FIELD 

as  possible  the  personnel  of  such  stations  will  be  obtained  from  the 
American  National  Red  Cross. 

HOSPITAL    SHIPS    AND    SHIPS    FOR   PATIENTS 

On  over-sea  expeditions  hospital  ships  and  ships  for  patients  may 
both  be  required.     They  will  be  provided  by  the  War  Department. 

Hospital  ships  are  IVIedical  Department  organizations  and  will 
be  used  solely  by  that  department.  Ships  for  patients  are  ordinary 
transports  or  vessels  turned  over  to  the  Medical  Department  for 
temporary  use  in  emergencies  when  hospital  ships  are  not  available. 

The  personnel  of  a  hospital  ship  (capacity  200  beds)  consists  of 
5  medical  officers  (i  lieutenant  colonel  or  major,  4  captains  and 
lieutenants);  5  noncommissioned  officers  (i  sergeant  first  class,  4 
sergeants)  ;  5  acting  cooks;  30  privates  first  class  and  privates  (29 
nurses,  i  orderly). 


THE  THEATER  OF  OPERATIONS 

THE    ZONE    OF    THE    ADVANCE 

The  sanitary  personnel  of  the  zone  of  the  advance  may  be  divided 
into  two  general  groups,  as  follows:  First,  that  attached  to  line 
organizations  smaller  than  a  brigade,  which  functions  under  the 
immediate  orders  of  the  organization  commanders ;  second,  that 
comprising  the  sanitary  trains,  which  functions  under  the  orders  of 
division  surgeons  in  accordance  with  such  general  or  specific  instruc- 
tions as  they  may  receive  from  their  division  commanders. 

(See  also   Field   Service  Regulations.) 

Sanitary  troops  with  line  organizations,  including  detachments 
with  regiments,  battalions,  trans,  etc.,  vary  in  personnel  with  the 
strength  of  the  organization  served  and  the  nature  of  the  duties 
they  are  required  to  perform.  (See  Tables  of  Organization :  War  — 
Regimental  Organisation.) 

When  a  regiment  is  operating  independently  the  Medical  Depart- 
ment equipment  available  for  its  use  consists  of  the  first-aid  packet 
carried  by  each  officer  and  enlisted  man  of  the  Army  as  a  part  of 
his  individual  equipment;  the  articles  carried  as  individual  equip- 
ment by  each  medical  officer  and  by  each  enlisted  man  of  the  medical 
•department;  the  combat  equipment;  the  camp  infirmary  equipment; 


THE  SANITARY  SOLDIER  IN  WAR  19 

and  the  additional  articles  necessary  for  the  establishment  of  a 
regimental  hospital. 

(a)  The  additional  articles  for  the  regimental  hospital  will  be 
taken  to  the  field  only  under  circumstances  requiring  the  organiza- 
tion to  provide  hospital  care  for  its  own  sick  and  wounded. 

When  a  regiment  or  other  line  organization  is  operating  as  a  part 
of  a  division  the  Medical  Department  equipment  provided  for  its 
exclusive  use  consists  of  the  first-aid  packets  and  individual  equip- 
ments mentioned  in  the  preceding  paragraph,  and  the  combat  equip- 
ment. A  small  box  of  surgical  dressings  and  one  or  more  litters 
are  carried  on  each  ammunition  wagon.  The  requisite  articles  for 
the  establishment  of  the  aid  station  are  carried  on  the  pack  mule 
allotted  the  sanitary  service,  which  marches  with  the  combat  train 
of  the  organization.  The  medical  officer  responsible  for  this  equip- 
ment will  see  that  it  is  complete  and  that  it  is  maintained  intact  for 
service  in  combat. 

(a)  On  the  march  and  in  camp,  with  the  exceptions  noted  in  para- 
graph 6oi,  M.  M.  D.,  the  medical  supplies  and  dispensary  service 
required  by  regimental  organizations  are  provided  through  the 
medium  of  the  camp  infirmary. 

(b)  In  combat  it  is  contemplated  that  the  expenditures  of  dress- 
ings, etc.,  from  the  equipment  of  regimental  organizations  will  be 
replenished  from  the  reserve  supplies  of  the  nearest  ambulance  com- 
pany or  camp  infirmary. 

On  the  march  the  duties  of  the  sanitary  personnel  are  to  render 
first  aid  where  required,  to  transport  the  sick  and  wounded,  and  to 
make  suitable  disposition  of  them  on  arrival  in  camp. 

Ordinarily  the  surgeon  marches  with  the  regimental  commander, 
and  one  medical  officer  marches  in  the  rear  of  each  battalion.  Each 
officer  is  mounted  and  accompanied  by  a  mounted  orderly.  The 
remaining  regimental  sanitary  personnel  usually  march  with  the 
battalion  units. 

When  out  of  the  presence  of  the  enemy,  ambulances  are  ordinarily 
ordered  distributed  by  the  division  commander  throughout  the 
column,  in  the  rear  of  regiments,  battalions,  etc.  Unless  otherwise 
ordered  these  ambulances  join  their  companies  at  the  end  of  the  day's 
march  or  at  the  beginning  of  an  engagement.  When  a  regiment 
operates  independently  it  may  be  assigned  its  full  quota  of  four 
ambulances. 


20  SANITARY  TROOPS  IN  POST  AND  FIELD 

A  soldier  falling  out  of  the  marching  column  from  sickness  or 
injury  is  sent  to  a  medical  officer  in  the  rear,  with  a  pass  from  his 
company  commander,  showing  the  soldier's  name  and  organization. 
The  medical  officer  returns  the  pass,  showing  the  disposition  made  of 
the  soldier.  The  man  may  be  given  authority  to  ride  in  the  ambu- 
lance at  the  rear  of  the  regiment,  or  his  arms  and  personal  equipment 
may  be  carried  in  the  ambulance,  and  he  may  march  at  the  rear  of 
the  regiment  with  the  sanitary  detachment. 

When  an  ambulance  at  the  rear  of  a  regiment  is  filled  it  may  fall 
out  and  join  its  company  at  the  rear  of  the  column,  and  the  director 
of  ambulance  companies  or  the  ambulance  company  commander 
may  send  forward  another  ambulance  to  take  its  place;  or  the 
ambulance  may  remain  with  the  regiment,  and  men  requiring  trans- 
portation may  be  given  diagnosis  tags  authorizing  their  transporta- 
tion by  the  ambulance  company  in  the  rear.  In  the  latter  case  the 
men  fall  out  and  repor-t  to  the  commander  of  the  ambulance  company 
•  for  transportation. 

The  arms,  personal  equipment,  and  clothing  of  a  soldier  who  falls 
out  are  taken  with  him  in  the  ambulance.  The  horse,  saber,  and 
horse  equipment  of  a  soldier  admitted  to  the  ambulance  or  otherwise 
separated  from  his  organization  because  of  sickness  or  injury  are 
taken  back  to  the  troops  by  the  noncommissioned  officer  who  accom- 
panied him. 

Upon  halting  for  the  night  all  but  the  trivial  cases  are  taken  in 
charge  by  a  field  hospital  designated  by  the  division  surgeon,  or  they 
are  sent  to  the  rear,  as  the  conditions  may  warrant.  It  may  be 
necessary  to  leave  them  under  shelter  —  in  houses,  if  practicable  — 
with  the  necessary  food  and  attendants  until  taken  in  charge  by 
sanitary  troops  from  the  line  of  communications. 

In  combat  the  duties  devolving  on  the  sanitary  personnel  are  to 
render  first  aid  to  the  wounded;  to  establish  and  operate  an  aid 
station,  and  to  collect  the  wounded  thereat ;  to  direct  those  with 
trivial  wounds  to  return  to  the  line,  and  to  direct  others  with  slight 
wounds  to  the  station  for  slightly  wounded ;  and  in  exceptional  cases 
to  transport  the  severely  wounded  to  the  dressing  station. 

The  detachment  invariably  accompanies  its  line  unit  in  combat, 
rendering  first  aid  to  as  many  as  possible  of  those  who  fall  out, 
without  losing  touch  with  the  command.  It  is  assisted  by  the  band 
if  the  latter  is  assigned  to  duty  with  the  sanitary  troops. 


THE  SANITARY  SOLDIER  IN  WAR  21 

Unless  medical  assistance  is 'available,  the  wounded  apply  their 
first-aid  packets,  if  practicable.  With  this  exception  the  care  of  the 
wounded  devolves  upon  the  sanitary  troops,  and  no  combatant,  unless 
duly  authorized,  is  permitted  to  take  or  accompany  the  sick  or 
wounded  to  the  rear. 

With  dismounted  troops  the  aid  station,  not  more  than  one  for 
each  regiment  or  smaller  independent  unit,  will  be  established  as  the 
engagement  develops  and  the  number  of  wounded  warrant  it,  pro- 
viding it  is  probable  that  the  command  will  remain,  for  a  short 
period  at  least,  near  the  proposed  location  of  the  station.  With  a 
mounted  command  the  sanitary  detachment  accompanies  the  troops 
during  the  whole  course  of  the  engagement,  pausing  only  so  long  as 
is  necessary  to  render  first  aid  and  to  collect  the  wounded  at  some 
place  where  they  can  be  turned  over  to  an  inhabitant  of  the  country 
to  be  cared  for.  The  commander  of  the  advancing  foot  troops  or  of 
the  advance  section  should  be  promptly  notified  of  the  location  of 
the  wounded  thus  collected. 

In  locating  the  aid  station  it  is  of  the  highest  importance  that 
advantage  be  taken  of  any  shelter  from  fire  which  the  terrain  affords. 
To  a  large  extent  the  distance  of  the  station  from  the  firing  line 
must  depend  upon  this  consideration.  It  will  be  borne  in  mind  that 
any  building  which  offers  a  good  target  for  artillery  fire  is  worse 
than  no  shelter  at  all,  and  that  the  nearer  the  station  is  to  the  front 
the  safer  it  will  be  from  dropping  projectiles. 

The  surgeon  remains,  as  a  rule,  at  the  aid  station,  with  a  non- 
commissioned officer  and  the  necessary  number  of  privates,  for  to 
this  station  the  commanding  officer  will  send  information  or  orders 
which  he  may  have  to  communicate  to  the  surgeon,  and  through  this 
station  the  surgeon  gains  contact  with  the  units  of  the  sanitary  train 
in  the  rear.  The  other  medical  officers  and  the  remainder  of  the 
detachment  keep  in  touch  with  the  firing  line,  tending  the  wounded 
as  far  as  possible  and  conveying  the  helpless  to  the  station,  if  prac- 
ticable. If  the  enemy's  fire  is  such  that  the  wounded  can  not  reach 
the  station  advantage  is  taken  of  trenches,  ravines,  and  other  inequal- 
ities of  the  ground  affording  temporary  shelter,  and  the  wounded  are 
brought  in  during  intervals  in  the  firing  or  after  nightfall. 

No  one  belonging  to  the  sanitary  personnel  of  an  organization 
will  go  farther  to  the  rear  than  the  aid  station,  except  by  authority 
of  the  surgeon. 


22 


SANITARY  TROOPS  IN  POST  AND  FIELD 


The  aid  station,  which  will  often  be  but  little  more  than  a  place 
for  assembling  the  wounded,  should  not  undertake  elaborate  or  fixed 
arrangements  for  their  care  and  treatment,  as  its  personnel  must 
keep  in  touch  with  the  regiment  and  be  prepared  to  close  or  move 
the  station  without  delay  when  the  regiment  moves.  The  treatment 
given  will  usually  be  limited  to  first  aid  and  to  the  readjustment  of 
dressings.  Occasionally  it  may  become  necessary  to  ligate  an 
artery  or  to  perform  an  emergency  operation.  Fractures,  if  not 
previously  immobilized,  should  be  put  in  splints.  Diagnosis  tags 
will  be  attached  to  all  wounded  and  the  duplicates  disposed  of  as 
directed  in  paragraph  571  M.  M.  D.  The  arms  and  equipment  of 
wounded  separated  from  their  companies  and  taken  in  charge  by 


Sanitary    Service  -  Divis 


tEOENO 
+   KcjimenUI  Aid  SUiion 
w    Dr«ft»inj  SlAtion 
O-Ambulanu  Co. 
GS  Field  Hospital  Set  Vp 
^Field  Hoepital  on  Wagons 
^Medical   Reserve 
^  Station  fjrSllAhtly  Wounded 
■  Evacuating   point 
A  Ambulance  Coa.  Sanitary  Column 
■D  Evacuation  Hospital  5'et  i/p 
,  ni.Eva(.uation  Hospital  on  ^a^ons 


J        ^h 


L*fC.Troo(M    J 


Fig.    I. —  Sanitary  Service.     Zones  of  Administration. 


the  Medical  Department  should,  so  far  as  practicable,  accompany 
them  until  they  reach  the  line  of  communications. 

In  the  course  of  battle  the  advance  of  troops  may  result  in  the 
aid  station  being  separated  so  far  from  the  line  that  it  can  no  longer 
fulfill  its  purpose.  In  this  case  it  must  be  advanced  to  a  more 
favorable  location.  Ordinarily  the  wounded  left  behind  will  be 
looked  after  by  the  advancing  ambulance  company,  but  if  it  is  appar- 
ent that  this  will  be  long  delayed  a  small  portion  of  the  regimental 
personnel  may  be  detailed  to  remain  with  them.  Similar  action  will 
be  taken  in  case  of  retreat.  The  closing  or  moving  of  the  station 
rests  on  the  decision  of  the  regimental  surgeon.     In  reaching  his 


THE  SANITARY  SOLDIER  IN  WAR  23 

decision  he  should  be  governed  by  tne  primary  necessity  of  always 
keeping  in  touch  with  the  regiment. 

The  sanitary  train  is  composed  of  camp  infirmaries,  ambulance 
companies,  and  field  hospitals.  It  is  commanded  by  the  division 
surgeon. 

CAMP    INFIRMARIES 

Each  regiment  of  a  division  has  assigned  to  it  in  time  of  peace  one 
camp  infirmary  equipment,  including  one  wagon  belonging  to  the 
divisional  sanitary  train.  (See  Tables  of  Organization:  Peace  — 
Regimental  Organizations.) 

When  the  division  is  assembled  the  camp  infirmary  equipments 
authorized  for  the  service  of  the  mobilized  division  (usually  on  th^ 
basis  of  one  for  each  brigade)  are  retained  for  duty  as  camp  infirm- 
aries. The  remaining  camp  infirmary  equipments,  except  trans- 
portation, are  turned  in  to  the  officer  in  charge  of  medical  supplies 
and  the  wagons  thus  released  are  assigned  to  those  units  of  the 
sanitary  train  for  which  no  transportation  is  provided  in  time  of 
peace. 

'the  ambulance  company 

The  personnel  of  an  ambulance  company  at  war  strength,  as  given 
in  Tables  of  Organization,  are  ordinarily  distributed  as  follows : 

(a)  With  the  dressing  station,  including  the  litter  bearers:  4  offi- 
cers, I  sergeant  first  class,  6  sergeants,  i  acting  cook,  40  privates 
first  class  and  privates,  all  of  the  Medical  Department. 

(&)  With  the  wheeled  transportation:  i  officer,  i  sergeant  first 
class,  I  sergeant,  i  acting  cook,  28  privates  first  class  and  privates 
(1  as  farrier,  i  as  saddler,  2  as  musicians,  12  as  ambulance  drivers, 
and  12  as  ambulance  orderlies),  all  of  the  Medical  Department;  also 
I  sergeant  (blacksmith)  and  3  privates  (drivers)  of  the  Quarter- 
master Corps. 

The  function  of  the  ambulance  company  is  to  collect  the  sick  and 
wounded,  to  afford  them  temporary  care  and  treatment  and  to  trans- 
port them  to  the  next  sanitary  unit  in  the  rear. 

In  camp  the  ambulance  company  operates  an  ambulance  service 
between  the  camp  infirmaries  and  the  field  or  other  hospitals. 

On  the  march  ambulances  are  distributed  among  the  marching 
troops,  usually  one  to  each  regiment,  for  the  purpose  of  supplying 
transportation  to  those  who  become  unable  to  march. 


24  SANITARY  TROOPS  IN  POST  AND  FIELD 

In  combat  the  company  operates  in  two  parts.  The  first  estab- 
lishes and  operates  a  dressing  station  and  collects  the  wounded 
thereat,  the  second  operates  the  wheeled  transportation  in  evacuating 
the  wounded. 

Ambulances  must  reach  the  dressing  station  as  early  as  possible 
even  at  the  risk  of  losses.  Ordinarily  ambulances  will  carry 
wounded  only  from  the  dressing  station  to  the  nearest  field  hospital, 
immediately  returning  to  the  former;  any  other  destination  for 
wounded  must  be  prescribed  by  the  division  surgeon. 

Whe  field  hospital 

(Capacity  216.) 

The  field  hospitals  will  be  numbered  from  i  upward  in  a  single 
consecutive  series  for  the  entire  military  establishment. 

The  wagons  of  the  field  hospital  will  be  marked  as  prescribed  in 
Tables  of  Organization. 

The  commanding  officer  of  the  field  hospital  is  under  the  imme- 
diate orders  of  the  director  of  field  hospitals,  when  there  is  one; 
otherwise  he  is  under  the  immediate  orders  of  the  division  surgeon. 

The  personnel  of  a  field  hospital  at  war  strength,  as  given  in 
Tables  of  Organization,  are  ordinarily  assigned  as  follows :  i  major 
(commanding)  ;  5  captains  and  lieutenants  (i  adjutant  and  quarter- 
master, 4  ward  surgeons)  ;  3  sergeants  first  class  (i  acting  first  ser- 
geant in  general  supervision  of  the  hospital  and  in  charge  of  medical 
property  and  records,  i  in  charge  of  transportation  and  quarter- 
master property  and  records,  i  in  charge  of  mess  supplies  and  cook- 
ing) ;  6  sergeants  ( i  in  charge  of  the  dispensary,  i  in  charge  of 
operating  equipment,  i  in  charge  of  patients'  clothing  and  effects,  3 
in  charge  of  wards);  3  acting  cooks;  55  privates  first  class  and 
privates  (46  attendants,  i  dispensary  assistant,  i  artificer,  4  orderlies, 
3  supernumeraries) ;  and  of  the  Quartermaster  Corps,  i  sergeant 
(wagon  master)  and  7  privates  (drivers). 

The  function  of  the  field  hospitals  is  to  keep  in  touch  with  the 
combatant  organizations  and  to  provide  shelter  and  such  care  and 
treatment  as  are  practicable  for  the  sick  and  wounded  of  the  division 
who  are  brought  in  by  the  ambulance  companies  until  the  sanitary 
service  of  the  line  of  communications  takes  charge  of  them.  A  field 
hospital  can  meet  these  requirements  only  when  it  is  relieved  so 
promptly  by  the  sanitary  units  in  the  rear  that  its  mobility  is  not 


THE  SANITARY  SOLDIER  IN  WAR  25 

interfered  with.  Prompt  evacuation  of  the  sick  and  wounded  is 
necessary  also  to  secure  for  them  the  facilities  for  treatment  and  the 
comforts  which  are  available  on  the  line  of  communications. 

On  the  march  and  in  temporary  camps,  however,  the  field  hospitals 
are  the  nightly  collecting  points  for  the  divisional  sick  and  injured 
who  are  unable  to  continue  the  march,  and  must  provide  for  the 
care  of  such  patients  until  they  can  be  turned  over  to  the  medical 
service  of  the  line  of  communications  or  to  a  local  hospital  or  hos- 
pitals. The  use  of  the  field  hospitals  for  this  purpose  should  be 
carefully  regulated  by  the  division  surgeon. 

(a)  So  far  as  practicable  in  each  division  only  one  field  hospital 
at  a  time  will  be  used  in  this  service,  leaving  the  others  entirely  free 
of  patients.  Furthermore,  only  so  much  of  the  equipment  of  the 
field  hospital  assigned  to  this  work  should  be  unpacked  as  is  required 
to  care  properly  for  the  patients  actually  in  the  hospitals  and  their 
necessary  attendants  who  are  to  remain  behind  when  the  division 
moves  on.  The  number  of  personnel  detailed  to  remain  will  be  as 
small  as  possible. 

(b)  The  equipment  which  has  not  been  unpacked  and  the  per- 
sonnel who  have  not  been  detailed  to  remain  with  the  patients  will 
move  with  the  division. 

(c)  Every  eflfort  will  be  made  by  the  division  surgeon  to  dispose 
of  the  patients  left  behind.  Should  unusual  delay  in  turning  them 
over  to  the  medical  service  of  the  line  of  communications  supervene, 
temporary  provision  for  them  should  be  arranged  in  civil  hospitals 
of  the  locality  or  otherwise  as  may  be  most  practicable  until  the 
medical  units  of  the  line  of  communications  can  take  charge  of  them. 

(d)  As  soon  as  the  patients  are  disposed  of,  the  personnel  detailed 
for  the  temporary  care  of  such  patients  will  immediately  rejoin  the 
hospital. 

On  the  receipt  of  an  order  to  open  a  field  hospital  the  following 
departments  will  be  established : 
Dispensary. 
Kitchen. 

Receiving  and  forwarding. 
Slightly  wounded. 
Seriously  wounded. 
Operating  room. 
Mortuary. 


26  SANITARY  TROOPS  IN  POST  AND  FIELD 

All  wounded  arriving  at  the  field  hospital  will  be  received  at  the 
receiving  and  forwarding  department,  which  is  the  administrative 
office  of  the  hospital. 

(a)  The  slightly  wounded,  able  to  walk,  will  be  immediately 
directed  to  the  rear  or  to  the  station  for  slightly  wounded,  as  the 
circumstances  may  indicate. 

(b)  The  seriously  wounded,  and  the  slightly  wounded  unable  to 
walk,  will  be  assigned  to  the  proper  department  for  treatment. 

(c)  Records  of  the  wounded  will  be  made  as  prescribed  in  para- 
graph 575  et  seq.  M.  M.  D. 

THE    STATION    FOR    SLIGHTLY    WOUNDED 

The  station  for  slightly  wounded  is  a  transient  divisional  organiza- 
tion on  the  battle  field ;  it  has  no  permanent  personnel  or  definitely 
prescribed  equipment. 

(a)  The  personnel  required  for  the  station,  usually  one  medical 
officer,  two  noncommissioned  officers,  and  eight  privates,  will  be 
detached  from  such  unit  of  the  sanitary  train  as  the  division  surgeon 
may  elect.  In  some  instances  it  may  be  practicable  to  utilize  per- 
sonnel sent  forward  from  the  line  of  communications. 

(b)  For  the  equipment  of  the  station  one  of  the  camp  infirmaries 
of  the  division  may  be  utilized,  or  a  medical  and  surgical  chest  and 
such  other  supplies  as  are  necessary  may  be  temporarily  detached 
from  one  of  the  field  hospitals. 

The  functions  of  the  station  for  slightly  wounded  are  (i)  to 
afford  a  place  where  men  who  are  unable  to  accompany  their  units 
into  combat  may  be  assembled;  (2)  to  relieve  dressing  stations  and 
field  hospitals  of  the  congestion  incident  to  the  presence  of  the 
slightly  wounded  w'ho  can  walk  and  who  require  but  little  attention. 

The  station,  usually  one  for  each  division,  is  established  when 
combat  is  imminent.  It  should  be  about  the  same  distance  from  the 
firing  line  as  the  field  hospitals.  A  building  should  be  selected  for 
its  use  when  practicable.  It  should  preferably  be  located  on  the 
route  over  which  the  troops  have  advanced,  as  this  route  is  the  one 
which  the  disabled  are  most  likely  to  follow  in  working  their  way  to 
the  rear.  In  any  case  it  should  be  so  conspicuously  marked  that  it 
can  be  found  readily. 

Extensive  preparations  at  this  station  are  unnecessary.     A  tent 


THE  SANITARY  SOLDIER  IN  WAR 


27 


should  be  erected,  if  no  building  is  available,  where  dressings  may 
be  applied  or  readjusted  and  arrangements  made  for  the  preparation 
of  simple  nourishment.  Diagnosis  tags  should  be  attached  to  all 
wounded  not  already  tagged.  The  duplicates  of  the  tags  will  be 
disposed  of  as  directed  in  paragraph  571  M.  M.  D.  A  list  of  sick 
and  wounded  wall  be  prepared  as  prescribed  in  paragraph  580 
M.  M.  D. 


Fig.   2. —  Line  of  Communications. 


THE    LINE    OF    COMMUNICATIONS 

The  line  of  communications  is  the  connecting  link  between  the 
service  of  the  interior  and  the  zone  of  the  advance.     It  is  estab- 


28  SANITARY  TROOPS  IN  POST  AND  FIELD 

lished  when  an  important  force  is  about  to  engage  in  field  operations 
involving  a  movement  from  a  base  unless  the  territory  through  which 
the  supply  services  extend  can  be  safely  occupied  without  military 
operations  of  an  extensive  character.  In  the  latter  case  administra- 
tion and  supply  are  accomplished  as  in  the  service  of  the  interior. 

The  line  ^f  communications  is  ordinarily  divided  into  a  base  sec- 
tion and  an  advance  section.  In  certain  cases,  due  to  prolongation 
of  the  line  of  communications,  an  intermediate  section  may  be 
required.  An  advance  section  is  required  at  the  head  of  each  impor- 
tant route  of  supply  diverging  from  the  base. 

The  mission  of  the  sanitary  service  of  the  line  of  communications 
is  (i)  to  provide  such  adequate  facilities  for  the  treatment  of  the 
sick  and  wounded  that  those  not  permanently  disabled  may  be 
returned  to  the  front  with  the  least  practicable  delay;  (2)  to  furnish 
such  an  efficient  evacuation  service  as  will  promptly  relieve  the 
fighting  forces  of  the  encumbrance  of  their  sick  and  wounded  and 
allow  the  sanitary  units  in  the  zone  of  the  advance  to  maintain  con- 
tact with  their  combatant  organizations;  (3)  to  organize  and  main- 
tain a  system  of  supply  that  will  enable  the  sanitary  troops  in  the 
theatre  of  operations  to  replenish  their  equipment  and  supplies  by 
direct  methods  and  without  delay;  (4)  to  maintain  satisfactory 
sanitary  conditions  among  the  troops  on  the  line  of  communications 
and,  if  necessary,  to  take  entire  charge  of  sanitation  among  the 
inhabitants  of  the  occupied  territory. 

The  Medical  Department  units  pertaining  to  the  line  of  com- 
munications are  the  follov/ing: 

Base  group. —  A  medical  supply  depot,  one  or  more  base  hospitals, 
and,  when  required,  convalescent  camps,  contagious  disease  hospi- 
tals, hospital  trains  and  trains  for  patients,  hospital  ships  and  ships 
for  patients,  casual  camps,  sanitary  squads,  field  laboratories,  and 
organizations  of  the  American  National  Red  Cross. 

Intermediate  group. —  Rest  stations,  organizations  of  the  Ameri- 
can National  Red  Cross,  and  such  other  sanitary  formations  as  may 
be  necessary. 

Advance  group. —  Two  evacuation  hospitals  and  one  evacuation 
ambulance  company  for  each  division  at  the  front  supplied  from  the 
advance  sectign,  and  an  advance  medical  supply  depot.  The  evacu- 
ation hospitals  and  evacuation  ambulance  companies  of  the  advance 
section  are  collectively  known  as  the  sanitary  column. 


THE  SANITARY  SOLDIER  IN  WAR  29 


THE    BASE    HOSPITAL 

(Capacity  500.) 


Base  hospitals  are  Medical  Department  units  of  the  line  of  com- 
munications under  the  supervision  of  the  surgeon,  base  group.  They 
will  occupy  buildings,  if  suitable  ones  are  available. 

THE    CONVALESCENT    CAMP 

In  appropriate  cases  convalescent  camps  may  be  established  in 
the  vicinity  of  base  hospitals.  Such  camps  will  be  branches  of  the 
base  hospital  near  which  they  are  situated. 

THE    CONTAGIOUS    DISEASE    HOSPITAL 

Ordinarily  cases  of  infectious  disease  occurring  among  troops 
in  the  theatre  of  operations  will  be  cared  for  in  the  isolation  wards 
of  base  or  other  hospitals  and  so  far  as  practicable  at  or  near  the 
place  of  origin  of  the  disease.  In  the  presence  of  a  serious  epidemic, 
however,  special  facilities  for  the  isolation  of  cases  may  be  required. 
In  this  event  the  surgeon,  base  group,  with  the  authority  of  the 
commander  of  the  line  of  communications,  will  organize  such  con- 
tagious disease  hospitals  as  may  be  necessary  to  meet  the  emergency. 

TRAINS,  BOATS,  AND    SHIPS 

The  general  regulations  governing  the  organization,  personnel, 
materiel  and  operation  of  hospital  trains,  trains  for  patients,  hos- 
pital ships,  and  ships  for  patients  in  the  service  of  the  interior  will 
apply  also  to  the  similar  medical  department  units  on  the  line  of 
communications,  except  that  the  duties  performed  by  the  Surgeon 
General  with  respect  to  the  former  will  devolve  in  the  latter  case 
upon  the  surgeon,  base  group. 

SANITARY   SQUADS 

For  the  purpose  of  giving  attention  to  sanitary  matters  not  within 
the  control  of  regimental  or  other  military  organizations,  sanitary 
squads  will  be  organized  on  the  line  of  communications  at  such 
places  as  may  be  necessary. 

The  personnel  of  such  squads  will  consist  of  enlisted  men  of  the 
Hospital  Corps  augmented  by  such  number  of  other  enlisted  men 


30  SANITARY  TROOPS  IN  POST  AND  FIELD 

and  civilian  laborers  as  the  amount  and  character  of  the  work  may 
justify.     Each  squad  will  be  in  immediate  charge  of  a  medical  officer. 

The  function  of  sanitary  squads  is  to  supervise  or  execute,  as 
the  case  may  be:  (i)  The  necessary  measures  for  the  sanitation  of 
camp  sites,  towns  or  villages  not  occupied  or  garrisoned,  or  of  such 
parts  of  the  same  as  may  be  otherwise  unprovided  for;  (2)  sanitary 
work  that  may  be  necessary  for  the  general  welfare  but  that  can  not 
be  performed  conveniently  or  profitably  by  individual  organizations ; 
(3)  the  operation  of  sanitary  apparatus  used  by  troops  in  common 
and  not  under  control  of  any  one  organization. 

Sanitary  squads  will  not  be  employed  to  relieve  regimental  and 
other  similar  organizations  of  the  duty  of  providing  for  the  sanita- 
tion of  their  own  camps. 

REST    STATIONS 

Rest  stations  are  organized  for  the  purpose  of  giving  temporary 
care  and  treatment  to  sick  and  wounded  en  route.  When  on  railway 
lines  those  established  on  the  line  of  communications  are  similar  in 
every  way  to  those  pertaining  to  the  service  "of  the  interior  and  their 
personnel  should,  if  practicable,  be  obtained  in  like  manner. 


THE  BASE  MEDICAL  SUPPLY  DEPOT 

A  medical  supply  depot  will  be  established  at  the  base.  The 
officer  in  charge  of  this  depot  will  prepare  in  quadruplicate  a  list  of 
all  supplies  required,  showing  the  maximum  and  minimum  quanti- 
ties of  each  article  which  should  be  kept  on  hand  in  the  depot, 
having  due  regard  in  formulating  this  estimate  to  the  number  of 
troops  to  be  supplied,  the  time  required  by  the  depot  to  replenish 
supplies,  the  character  of  the  military  operations  in  prospect,  etc. 
In  stating  the  minimum  quantity  of  supplies  the  supply  officer  should 
include  at  least  one  medical  reserve  unit  for  each  division  at 
the  front,  in  addition  to  the  supplies  likely  to  be  required  by  the 
sanitary  formations  on  the  line  of  communications.  Three  copies 
of  the  above-mentioned  list  will  be  forwarded  through  military 
channels  to  the  commander  of  the  military  forces.  When  approved, 
one  copy  will  be  retained  at  the  headquarters  of  the  commander  of 
the  field  forces,  one  copy  will  be  sent  to  the  Surgeon  General,  and 
one  copy  will  be  returned  to  the  officer  in  charge  of  the  depot. 


THE  SANITARY  SOLDIER  IN  WAR  31 

THE  ADVANCE   MEDICAL   SUPPLY   DEPOT 

The  Stock  on  hand  at  this  depot  will  be  considered  a  part  of  the 
available  supply  of  the  base  depot,  as  far  as  the  table  fixing  the 
maximum  and  minimum  stock  limits  is  concerned, 

THE    EVACUATION    HOSPITAL 
(Capacity  432.) 

The  evacuation  hospitals  are  Medical  Department  units  belonging 
to  the  line  of  communications.  Ordinarily  two  evacuation  hosptals 
will  be  assigned  to  a  line  of  communications  for  each  division  which 
it  serves  in  the  zone  of  the  advance.  They  will  be  numbered  and 
designated  like  the  base  hospitals. 

The  primary  function  of  the  evacuation  hospital  is  to  replace  field 
hospitals  so  that  the  latter  may  move  with  their  divisions,  or  to  take 
over  their  patients  with  the  same  object  in  view,  so  far  as  it 
may  be  practicable. 

THE    EVACUATION    AMBULANCE    COMPANY 

Evacuation  ambulance  companies  are  organized  only  in  time  of 
war  or  when  war  is  imminent.  They  are  allowed  in  the  proportion 
of  one  for  each  division  at  the  front.  They  will  be  numbered  con- 
secutively from  I  upward  for  each  field  army  to  which  they  belong, 
as  "  Evacuation  Ambulance  Company  No.  i,  3rd  Field  Army." 

The  primary  function  of  the  evacuation  ambulance  company  is 
the  evacuation  of  field  hospitals  and  the  transportation  and  care  of 
patients  en  route  therefrom  to  evacuation,  base,  or  other  hospitals 
on  the  line  of  communications  or  to  points  with  train  or  boat  connec- 
tions for  rail  or  water  transport  to  such  hospitals. 

ADMINISTRATION 

For  administration  and  control  the  line  of  communications  is 
organized  as  follows : 

(i)  A  service  of  defense. 

(2)  A  supply,  sanitary,  and  telegraph  service. 

(3)  A  service  of  military  railways. 

All  personnel  pertaining  to  the  sanitary  service  of  the  line  of 
communications  report  at  the  base  for  assignment  to  duty.  Here 
advance  and  intermediate  sections  are  organized  and  sent  forward 
as  required. 


32  SANITARY  TROOPS  IN  POST  AND  FIELD 


RESUME    OF    THE    OPERATIONS    OF    THE    SANITARY 
SERVICE    IN    WAR 

When  war  is  imminent,  the  Regular  Army  is  mobilized  at  its 
permanent  posts  or  stations  and  the  Organized  Militia  at  mobiliza- 
tion camps.  Ltttle  is  required  of  the  Medical  Department  at  the 
time  of  mobilization  in  connection  with  the  preparation  of  organiza- 
tions of  the  Regular  Army  for  active  service.  Field  equipment  is 
maintained  at  designated  stations  or  depots  in  readiness  for  service 
at  all  times ;  the  men  of  the  Hospital  Corps  available  for  service 
with  line  organizations  and  with  the  sanitary  train  are  designated 
in  time  of  peace  and  are  in  readiness  to  join  their  respective  units. 
The  men  composing  the  line  organizations  have  been  given  thorough 
physical  examinations  which  have  been  made  of  record,  and  they 
have  been  vaccinated  against  smallpox  and  typhoid  fever.  Each 
man  is  equipped  with  a  first-aid  packet  and  has  been  instructed  in 
its  use.  So  far  as  the  Medical  Department  is  concerned,  therefore, 
these  troops  should  be  in  readiness  to  proceed  from  their  points  of 
mobilization  to  the  camps  of  concentration  on  short  notice. 

Mobilization  camps  for  the  Organized  Militia  are  provided  in 
each  State.  An  officer  of  the  Regular  Army  commands  each  camp 
and  has  on  his  staff  a  camp  surgeon,  usually  a  medical  officer  of  the 
Regular  Army.  Mobilization  camps  are  operated  under  the  control 
of  department  commanders,  who  are  responsible  for  the  complete 
preparation  and  equipment  of  the  troops  which  assemble  there. 
The  work  of  the  Medical  Department  at  these  camps  is  supervised 
by  the  department  surgeon  and  the  sanitary  inspector  of  the  depart- 
ment. The  camp  surgeon  is  provided  with  an  adequate  corps  of 
assistants.  Physical  examinations  of  troops  mobilized  are  made  and 
recorded  in  accordance  with  specific  instructions  from  the  War 
Department.  Vaccinations  against  smallpox  and  typhoid  fever  are 
administered  and  records  made  thereof.  Individuals  and  organiza- 
tions are  furnished  such  portions  of  their  equipment  as  pertain  to 
the  Medical  Department;  and  such  training  in  sanitary  matters  is 
given  both  the  line  troops  and  the  sanitary  troops  as  is  possible,  and 
appropriate  to  each.  When  for  any  reason  it  is  impracticable  to 
fully  prepare  individuals  and  organizations  for  service  at  the  front, 
so  far  as  this  preparation  devolves  upon  the  Medical  Department, 


THE  SANITARY  SOLDIER  IN  WAR  33 

the  camp  surgeon  will  furnish  a  full  report  to  the  department 
surgeon  showing  what  remains  to  be  done  in  order  that  the  latter 
may  take  the  necessary  steps  to  have  the  preparation  of  such  indi- 
viduals and  organizations  completed  at  the  camp  of  concentration. 

After  mobilization,  equipment,  and  preliminary  training,  the 
troops  are  assembled  at  concentration  camps  for  immediate  use 
against  the  enemy  or  for  transport  to  an  over-sea  theater  of  opera- 
tions. At  camps  of  concentration  the  general  instruction  and  train- 
ing of  line  and  sanitary  troops  in  connection  with  the  work  of  the 
sanitary  service  is  conducted  under  the  direction  of  the  camp 
surgeon. 

On  leaving  camps  of  concentration,  troops  pass  from  the  service 
of  the  interior  to  the  theater  of  operations,  where  they  came  under 
the  control  of  the  commander  of  the  field  forces.  They  may  pass 
directly  into  the  zone  of  the  advance  or  they  may  traverse  the  zone 
of  the  line  of  communications  before  reaching  the  zone  of  the 
advance,  or  they  may  be  assigned  to  duty  on  the  line  of  communica- 
tions. In  the  latter  case  they  may  be  assigned  either  to  the  service 
of  defense,  to  the  supply,  sanitary,  and  telegraph  service,  or  to  the 
service  of  military  railways.  The  relations  and  duties  of  the  sani- 
tary personnel  in  this  zone  are  described  in  paragraphs  751  to  827 
M.  M.  D. 

The  sanitary  service  of  the  zone  of  the  advance  is  treated  in 
detail  in  paragraphs  630  to  750  M.  M.  D.  The  purpose  of  the  service 
in  camp,  on  the  march,  and  in  combat  is  to  render  temporary  aid  to 
the  sick  and  wounded  and  to  expedite  their  transportation  to  the 
rear,  always  making  such  disposition  as  will  secure  the  retention  at 
the  front  of  all  men  fit  for  duty  and  relieve  the  fighting  force  of 
the  impediment  incident  to  the  presence  of  men  incapacitated  for 
duty.  To  that  end  the  service  of  the  advance  is  assisted  by  the 
service  of  the  line  of  communications,  if  one  has  been  organized ; 
otherwise  directly  by  the  service  of  the  interior.  In  either  event  it 
cooperates  with  the  advance  station  of  the  service  in  its  immediate 
rear.  When  battle  is  imminent,  the  resources  of  the  sanitary  service 
behind  the  zone  of  the  advance  are  placed  in  readiness  to  meet  the 
demands  for  the  care  and  transportation  of  the  wounded  which  may 
reasonably  be  expected,  and  personnel  and  supplies  are  advanced  as 
near  the  seat  of  operations  as  practicable,  reaching  forward  into  the 
zone  of  the  advance  if  conditions  warrant  it. 
3 


34  SANITARY  TROOPS  IN  POST  AND  FIELD 

The  troops  engaged  in  combat  are  accompanied  by  medical  officers 
and  Hospital  Corps  attendants;  ordinarily  a  medical  officer  with  a 
detachment  of  Hospital  Corps  men  accompanies  each  battalion  into 
combat,  and  the  surgeon  of  each  regiment  with  the  equipment  carried 
on  a  pack  mule  establishes  an  aid  station.  The  wounded  apply 
their  own  first-aid  dressings,  if  practicable,  and  the  sanitary 
personnel  attached  to  organizations  render  first  aid  as  soon  as  pos- 
sible. The  sanitary  personnel  with  each  battalion  collect  the 
wounded  in.  groups  and  transport  those  who  are  unable  to  walk  to 
the  regimental  aid  station.  Men  with  trivial  wounds  are  sent  back 
to  their  commands  when  their  wounds  are  dressed,  and  those  slightly 
wounded  but  able  to  walk  are  directed  to  the  station  for  slightly 
wKDunded  several  miles  in  the  rear,  in  order  that  dressing  stations 
and  field  hospitals  may  not  be  unnecessarilv  congested  by  the 
presence  of  this  class  of  men. 

At  the  aid  stations  the  sanitary  service  with  troops  connects 
with  the  service  of  the  sanitary  train.  Each  ambulance  company 
establishes  a  dressing  station  in  a  protected  location  usually  some 
distance  in  rear  of  the  aid  station.  The  dressing  stations  send  for- 
ward bearers  to  remove  the  wounded  who  have  been  brought  in  to 
the  aid  stations.  At  the  dressing  stations  light  nourishment  is  pro- 
vided, dressings  are  examined  and  adjusted  or  reapplied,  as  condi- 
tions may  require,  and  the  patients  who  require  transportation  are 
made  as  comfortable  as  possible  until  it  is  practicable  to  transport 
them  to  the  rear,  usually  to  the  field  hospitals.  Whenever  possible 
the  dressing  stations  are  so  located  that  they  can  be  reached  by 
wheel  transportation,  and  the  wounded  are  sent  to  the  field  hospitals 
in  ambulances. 

The  field  hospitals  do  not  perform  the  functions  of  civil  hospitals 
or  of  base  or  general  hospitals,  in  that  their  equipment  is  limited 
to  those  things  necessary  to  provide  shelter,  nourishment,  and 
emergency  treatment  for  patients  until  they  can  be  transferred  to 
the  immobile  units  at  the  rear.  At  the  field  hospitals  no  beds  or 
cots  are  provided.  The  patients  are  placed  on  straw  over  which 
blankets  are  spread.  The  service  of  the  zone  of  the  advance  con- 
trolled by  the  division  surgeon  terminates  with  the  field  hospitals. 
The  units  of  the  line  of  communications  pushed  forward  into  the 
zone  of  the  advance  relieve  the  field  hospitals  of  their  sick  and 
wounded  as  rapidly  as  possible. 


THE  SANITARY  SOLDIER  IN  WAR  35 

One  of  the  evacuation  hospitals  held  in  readiness  at  the  head  of 
the  line  of  communications  will  ordinarily  receive  the  patients  from 
the  field  hospitals.  In  some  cases  an  evacuation  hospital  is  pushed 
forward  and  takes  charge  of  the  patients  at  the  location  of  the  field 
hospital;  in  other  cases  transportation  from  the  advance  section  of 
thp  line  of  communications  is  sent  forward  to  the  field  hospital  to 
receive  the  patients,  and  in  many  cases  the  wagons  going  to  the  rear 
for  supplies  will  transport  the  patients  back  to  the  refilling  point 
where  they  will  be  turned  over  to  the  wagons  sent  forward  from  the 
advance  section.  The  evacuation  hospital  is  the  first  sanitary  unit 
in  which  provision  is  made  to  retain  patients  for  any  length  of  time. 
It  is  equipped  with  cots,  blankets,  and  a  liberal  supply  of  comforts 
for  the  sick,  but  ordinarily  the  evacuation  hospitals  will  be  cleared 
of  patients  as  early  as  practicable  in  order  that  they  may  be  ready 
to  receive  others  from  the  front.  The  patients  are  usually  sent  back 
by  trains  or  boats  to  the  base  hospitals  where  all  possible  comforts 
and  facilities  for  their  care  are  provided.  All  sick  and  wounded  who 
will  be  able  to  return  to  duty  within  a  reasonable  time  will  be  retained 
at  their  hospitals  rather  than  turned  over  to  the  service  of  the  inte- 
rior. Patients  who  no  longer  need  medical  attention  are  placed  in 
convenient  camps  operated  in  connection  with  the  base  hospitals  until 
they  regain  sufficient  strength  to  return  to  their  commands.  The 
base  is  the  great  center  of  medical  activity  of  an  army.  Personnel 
and  supplies  intended  for  the  Army  are  accumulated  here  and  sent 
forward  as  required.  The  sick  and  wounded  are  sent  back  to  the 
base  and  cared  for.  Records  of  both  supplies  and  personnel  are 
kept  at  the  base,  and  such  abstracts  and  tabulations  as  the  chief 
surgeon  of  the  field  army  may  require  from  time  to  time  are  made 
here  and  supplied  to  him. 

The  losses  at  the  front  are  being  constantly  replaced  by  men  sent 
forward  through  the  channels  above  described.  New  recruits  are 
sent  to  the  mobilization  camps  where  they  are  equipped  and  drilled 
and  pushed  forward  to  meet  the  demands  in  the  zone  of  the 
advance. 

Supplies  furnished  by  the  Medical  Department  for  troops  at  the 
front  are  ordinarily  obtained  through  the  supply  depot  at  the  head 
of  the  line  of  communications  on  requisitions  approved  by  the  divi- 
sion surgeon.  Each  sanitary  formation  may  make  its  own  requisi- 
tion, and  its  supplies  may  be  sent  forward  from  the  advance  section 


36  SANITARY  TROOPS  IN  POST  AND  FIELD 

to  the  refilling  points  where  the  transportation  furnished  by  the  line 
of  communications  turns  over  the  supplies  to  the  transportation  sent 
back  from  the  divisional  organizations.  The  stream  of  supplies 
coming  forward,  consisting  of  rations,  clothing,  and  ammunition,  is 
constant,  and  ample  opportunity  is  afforded  to  bring  up  the  articles 
required  by  the  sanitary  service  with  the  other  supplies.  When 
found  to  be  more  convenient  the  regimental  sanitary  supplies  may 
be  replenished  from  camp  infirmaries  or  from  the  supplies  carried 
by  the  ambulance  companies,  these  latter  making  requisitions  for  the 
supplies  which  they  require.  The  supply  depot  at  the  advance  sec- 
tion draws  its  supplies  from  the  depot  at  the  base,  the  stock  of  which 
is  automatically  maintained  by  the  service  of  the  interior. 


PART  II 

ANATOMY    AND    PHYSIOLOGY 

In  order  that  the  hospital  corps  man  may  intelligently  perform 
his  numerous  duties  in  connection  with  the  sick  and  wounded,  it  is 
necessary  that  he  should  understand  something  of  the  structure  of 
the  human  body  and  the  functions  of  its  various  organs.  It  is  not 
intended  to  give  him  that  little  incomplete  knowledge  that  is  a  "  dan- 
gerous thing,"  but  rather  a  knowledge  which,  while  not  like  that  of  a 
physician,  is  complete  as  far  as  it  goes. 

'^*^l  — A 


CHAPTER  I 


—  B 


THE    SKELETON   AND   JOINTS 

The  skeleton  is  the  bony  framework  of  the 
body,  gives  it  stability  and  form,  and  protects  the 
organs,  while  the  joints  permit  of  motion. 

Bone,  is  composed  of  about  one-third  animal 
matter,  mostly  gelatin,  and  two-thirds  mineral 
matter,  chiefly  lime  salts.  The  animal  matter 
gives  bone  its  toughness  and  elasticity ;  this  may 
be  demonstrated  by  leaving  a  bone  for  some  time 
in  dilute  acid  by  which  the  mineral  matter  is  re- 
moved and  the  gelatin  alone  is  left ;  the  bone 
may  then  be  tied  in  a  knot.  The  mineral  matter 
gives  the  bone  its  hardness ;  the  animal  matter  is 
all  removed  by  burning  the  bone  which  then  be- 
comes brittle  as  chalk.  Young  bones  contain 
more  animal  matter  and  are  hence  tougher  and 
harder  to  break ;  when  they  do  break,  the  fracture , 
is  apt  to  be  incomplete  like  a  broken  green  stick. 
Elderly  persons'  bones  break  easily  because  they  F'g.  3.— Section  of  Fe- 

.  mur.       A,   A,   Cancellous 

contain  more  mineral  matter.  tissue;  b,  compact  tissues. 

{2>7) 


—  A 


38 


ANATOMY  AND  PHYSIOLOGY 


If  you  saw  a  long  bone  across,  the  end  will  be  found  spongy  or 
cancellous,  while  the  shaft  is  compact  and  dense.  The  shaft  is  also 
hollow  and  contains  marrow  (Fig.  3). 

Bone  is  covered  by  a  vascular  membrane,  the  periosteum,  which 
nourishes  the  bone ;  where  the  periosteum  is  stripped  off,  the  bone  is 

apt  to  die  from  insufficient 
nourishment,  the  death  of 
the  bone  being  known  as 
caries  or  necrosis. 

The  bones  of  the  human 
body  number  about  two 
hundred,  without  counting 
the  thirty-two  teeth  and 
some  accessory  small 
bones;  taken  together  with 
the  cartilages  they  compose 
the  skeleton.  Cartilage,  or 
gristle,  is  an  elastic  sub- 
stance, like  bone  without 
mineral  matter;  it  is  seen 
extending  from  the  lower 
ribs  to  the  breast  bone  and 
covering  the  ends  of  the 
Jong  bones. 

The  bones  are  classified 
as  long,  short,  flat,  and 
irregular. 

The  long  bones,  of  which 
the  thigh  bone  is  an  exam- 
ple, form  a  system  of  levers 
which  support  the  weight 
of  the  body  and  provide  the 
means  of  locomotion.  The 
short  bones,  such  as  those 
of  the  wrist,  are  found 
where  strength  and  limited 
motion  are  the  requisites; 
the  flat  bones,  of  which  the 
bones  of  the  skull  are  an 


Fig.  4.—  Skeleton 


THE  SKELETON  AND  JOINTS 


39 


example,  serve  principally  for  protection;  the  irregular  bones  are 
illustrated  by  those  of  the  pelvis. 

In  considering  the  skeleton  (Fig.  4)  let  us  start  from  the  vertebral 
column,  also  called  the  spinal  column,  spine,  or  backbone.  The 
name  vertebra  is  given  to  each  separate 
bone  composing  the  column.  The  sep- 
arate bones  are  not  allowed  to  rub 
against  each  other,  but  are  separated 
by  pads  or  buffers  of  elastic  cartilage, 
and  at  the  same  time  tied  together  with 
Strong  fibrous  ligaments. 

These  buffers  of  intcrvertebrcl  sub- 
stance break  up  and  distribute  the 
shock  which  would  otherwise  result 
from  falls  or  in  jumping. 

On  looking  at  the  spine  (Fig.  5)  it 
will  be  observed  that  it  increases  in 
size  from  above  downward,  which  is 
but  natural  when  one  considers  the 
increase  in  weight  to  be  borne  by  the 
lower  part  as  compared  with  the  upper. 
The  highest  vertebrae,  those  of  the 
neck,  seven  in  number,  and  called 
cervical,  support  the  head  only.  Next 
in  order  come  the  twelve  dorsal,  which 
in  addition  support  the  ribs,  chest,  and 
upper  extremities.  In  the  next  region, 
the  small  of  the  back,  are  found  the 
five  massive  lumbar  vertebrae,  which 
have  the  entire  trunk  to  support.  The 
vertebral  column  ends  in  two  large  masses  of  bone  known  as  the 
sacrum  and  the  coccyx  or  tailpiece.  In  the  growing  youth  the 
sacrum  is  composed  of  five  separate  bones  and  the  coccyx  of  four, 
but  in  the  adult  these  separate  bones  are  welded  into  one  mass. 

Each  vertebra  consist  of  a  solid  body  in  front  and  an  arch  en- 
closing a  central  cavity  behind.  When  the  vertebrae  are  in  their 
natural  position  one  resting  upon  another,  the  arches  together  form 
a  canal,  the  spinal  canal,' v^hxch.  in  the  living  body  contains  and  pro- 
tects the  spinal  cord. 


,Jf 


Fig.  s. —  Spinal  Column.  A, 
Cervical;  B,  dorsal;  C,  lumbar; 
D,  sacrum;  E,  coccyx. 


40 


ANATOMY  AND  PHYSIOLOGY 


This  spinal  cord  is  everywhere  in  contact  with  the  bony  canal  in 
which  it  lies,  so  that  when  a  fracture  or  dislocation  of  the  spinal 
column  occurs  a  laceration  of  the  cord  is  almost  certain  to  occur, 
and  it  is  this  coincident  injury  to  the  cord  which  gives  to  these 
injuries  their  special  importance. 

If  the  fingers  are  drawn  along  the  center  of  one's  back  they  come 
in  contact  with  a  number  of  projecting  bony  points;  these  are  the 

spinous  processes  of  each 
vertebra  and  are  situated 
on  the  back  of  the  arch. 

Both  the  sacrum  and 
coccyx  take  part  in  the 
formation  of  the  large 
girdle  of  bone  met  with  at 
the  lower  part  of  the  trunk 
under  the  name  of  the 
pelvis,  or  basin  (Fig.  6), 
and  which  receives  the 
weight  of  the  body  and 
hands  it  over  to  the  lower 
extremities  at  the  hip 
joints.  The  sacrum  forms 
the  keystone  of  the  arch, 
the  sides  of  which  are  composed  of  the  two  innominate  bones  or 
nameless  bones,  separated  in  front  by  a  pad  of  cartilage,  and  all 
locked  together  by  powerful  ligaments. 

Within  the  pelvis  are  situated  the  urinary  bladder  in  front  and  the 
rectum  behind,  and,  in  the  female,  between  the  two  is  placed  the 
uterus.  Each  innominate  bone  consisted  originally  of  the  three 
bones,  the  ilium,  ischium,  and  pubis,  but  these  become  fused  to- 
gether so  as  to  form  one  bone  in  the  adult.  On  each  side  of  the 
pelvis  is  seen  a  cup-shaped  cavity  in  the  innominate  bone,  known  as 
the  acetabulum,  the  purpose  of  Avhich  is  to  receive  the  spherical  head 
of  the  femur,  so  as  to  make  the  hip  joint. 

A  joint  is  the  place  where  two  bones  meet  and  move  upon  each 
other;  the  ends  of  the  bones  are  covered  with  smooth  cartilage  and 
to  still  further  prevent  friction  the  cartilages  and  the  whole  joint  are 
enclosed  in  a  smooth,  glistening  membrane,  the  synovial  membrane, 
which  secretes  the  synovia  or  joint  oil. 


Fig.  6. —  Pelvis. 
A,  Innominate  bone;  B,  sacrum;  E,  coccyx. 


THE  SKELETON  AND  JOINTS 


41 


Outside  the  synovial  membrane  the  bones  are  firmly  bound  to-" 
gether  by  fibrous  ligaments,  while  the  joint  is  still  further  strength- 
ened by  the  surrounding  muscles.     A  joint,  therefore,  consists  of 
bones,  cartilages,  synovial  membrane,  and  ligaments. 

Joints  differ  very  much  in  their  character  and  the  kind  of  motion 
they  permit.  Thus  we  have  the  almost  perfect  freedom  of  motion 
permitted  by  the  ball-and-socket  joints,  like  the  shoulder  and  hip,  the 
more  limited  motion  of  hinged  joints,  like  the  knee,  and  the  almost 
motionless,  imperfect  joints,  such  as  the  sutures  of  the  skull. 

A  dislocation  is  a  slipping  away  of  the  joint  surfaces  from  each 
other  to  such  an  extent  that  they  remain  "  out  of  place  "  and  the 
joint  is  locked;  in  such  a  deep,  strong  joint  as  the 
hip,  violence  is  more  apt  to  give  rise  to  fracture 
than  to  dislocation. 

Entering  into  the  formation  of  the  hip  joint  is 
the  thigh  bone  or  femur  (Fig.  7),  the  largest  and 
longest  bone  in  the  body..  Like  other  long  bones 
it  has  a  shaft  and  two  extremities.  The  upper  ex- 
tremity consists  of  a  head,  neck  and  two  trochanters. 
The  head  is  globular  and  attached  to  the  shaft  by  a 
narrow  neck  set  at  an  angle;  it  is  in  this  narrow 
neck  that  fracture  so  frequently  occurs. 

The  trochanters  are  merely  bony  knobs  to  which 
muscles  are  attached  to  move  the  joints;  the  great 
trochanter  is  the  bone  which  you  may  feel  just 
under  the  skin  on  the  outer  side  of  the  hip.  The 
lower  extremity  of  the  femur  is  expanded  into  two 
broad  condyles  which  with  the  upper  end  of  the 
tibia  or  shin-bone,  and  the  patella  or 
knee-cap  (Fig.  8)  form  the  knee-joint. 
The  patella  is  the  small  round  bone  lying 
just  in  front  of  the  knee  and  in  the  ex- 

fJo'  8.—  tended  position  of  the  leg  is  freely  mov- 

Pateiia.       ^■^^^  ^j^l^  ^1^^  tcndou  in  which  it  lies. 

The  knee  joint  is  the  largest  in  the  body  and  from  its  exposed 
position  one  of  those  most  liable  to  injury;  once  injured  it  is  apt  to 
be  sensitive  ever  afterward. 

Beyond  the  knee  we  come  to  the  leg  composed  of  the  tibia  on  the 
inside  and  the  fibula  or  splint  bone  on  the  outside  (Fig.  9).     The 


r 


Fig.  7. —  Femur. 


42 


ANATOMY  AND  PHYSIOLOGY 


III 


tibia  is  a  strong  prism-shaped  bone,  the  inner  surface  and  front 
edge  just  beneath  the  skin  and  constituting  the  shin; 
on  account  of  its  being  just  beneath  the  skin,  frac- 
tures of  this  bone  are  apt  to  be  compound.  The 
fibula  is  a  long  slender  bone  deeply  buried  under 
the  muscles;  it  is  frequently  broken  just  above  the 
ankle  where  it  can  be  felt;  such  a  break  is  known 
as  a  "  Pott's  fracture." 

The  ankle  joint  is  made  up  of  the  tibia  and  fibula 
above  and  the  astragalus  below ;  it  is  a  strong  joint, 
so  much  so  that  while  it  is  frequently  subjected  to 
violent  wrenches  and  strains,  dislocation  seldom 
occurs;  under  such  conditions  the  joint  surfaces  do 
not  slip  entirely  away  from  each  other,  but  the  liga- 
ments and  synovial  membrane  are  torn  and  blood 
is  poured  out  into  and  about  the  joint,  constituting 
the  condition  known  as  sprain. 

Beyond  the  ankle  is  the  foot,  composed  of  the 
larsus,  metatarsus,  and  phalanges.  The  tarsus,  be- 
sides the  astragalus,  already  referred  to  as  helping 
to  form  the  ankle  joint,  contains  the  os  calcis  or 
heel  bone,  and  five  other  small  bones,  making,  seven 
in  all. 

The  metatarsus  lies  in  that  part  of  the  foot  just 
behind  the  toes,  and  is  composed  of  five  long  bones. 
The  phalanges  or  toe  joints  are  so  called  because 
they  are  arranged  in  phalanx  or  rows;  there  are 
three  for  each  toe  except  the  great  toe  which  has  only  two. 

To  go  back  to  the  vertebral  column.  Connected  with  its  dorsal 
portion  are  twelve  ribs  on  each  side,  and  closing  in  the  space  between 
the  ribs  in  front  so  as  to  form  the  thorax  is  the  breast  bone  or 
sternum. 

It  is  scarcely  necessary  to  say  that  the  number  of  ribs  is  the  same 
in  man  as  in  woman,  though  there  is  an  old  tradition  that  Adam  lost 
one  rib  in  order  to  gain  a  wife.  The  seven  upper  ribs  are  connected 
directly  to  the  sternum  in  front  by  their  cartilages  and  are  known  as 
true  ribs;  the  fire  remaining  are  known  as  false  ribs,  and  the  last  two 
which  are  not  connected  with  those  above  are  known  as  floating  ribs. 
The  breast  bone  or  sternum  is  composed  of  three  parts  and  extends 


Fig.  9. —  Tibia  and 
Fibula. 


THE  SKELETON  AND  JOINTS 


43 


from  the  root  of  the  neck  to  the  pit  of  the  stomach.  The  thorax  or 
chest  so  formed  is  a  bony  cage  which  encloses  and  protects  the  heart 
and  lungs;  it  is  separated  from  the  abdomen  by  a  broad,  muscular 
partition,  arching  upward  and  known  as  the  diaphragm. 

Connected  with  the  thorax  is  the  upper  extremity  composed  of 
the  shoulder  and  shoulder  joint,  arm,  elhozv  joint,  forearm,  zvrist 
joint,  and  hand. 

The  shoulder  is  composed  of  the  clavicle  or  collar  bone  and  the 
scapula  or  shoulder  blade.    The  clavicle  (Fig.  lo)  is  a  very  strong 


Fig.  10. —  Clavicle. 

bone  with  a  double  curve  like  the  Italic  letter  s.  It  is  connected  at 
one  end  with  the  breast  bone  and  at  the  other  with  a  process  of  the 
shoulder  blade  known  as  the  acromion;  it  is  the  acromion  process 
which  we  feel  just  under  the  skin  at  the  point  of  the  shoulder.  The 
clavicle  notwithstanding  its  strength 
is  very  frequently  broken  owing  to  „,  , 
its  fixed  position  and  the  fact  that 
it  receives  the  jars  transmitted 
through  the  upper  extremity  when 
one  tries  to  save  himself  in  falling 
by  throwing  out  the  arm.  The 
scapula  (Fig.  ii)  is  a  freely  mov- 
able flat  bone  connected  at  one  end 
with  the  collar  bone  to  form  the 
arch  of  the  shoulder;  its  outer 
angle  or  head  contains  a  shallow, 
saucer-shaped  depression  known  as 
the  glenoid  cavity  for  the  reception 
of  the  head  of  the  humerus  to  form 
the  shoulder  joint.  The  shoulder, 
like  the  hip,  is  a  ball-and-socket 
joint,  but  unlike  the  hip,  the  socket 

is  very  shallow,  so  that  the  head  of  the  humerus  in  the  very  free 
motion   permitted    easily   rolls    over   the    edge    and    becomes    dis- 


Fic.  II. —  Scapula. 


44 


ANATOMY  AND  PHYSIOLOGY 


:^v 


located;  as  a  matter  of  fact  dislocation  at  the  shoulder  joint  is 
many  times  more  frequent  that  at  all  the  other  joints  of  the  body 
put  together,  so  that  in  obscure  injuries  to  the  shoulder  we  always 
look  for  dislocation. 

The  arm  is  that  portion  of  the  upper  extremity  which  lies  between 
the  shoulder  and  elbow ;  like  the  thigh  it  contains  but  one  bone,  the 
humerus  (Fig,  12).  The  upper  end  of  the  humerus 
consists  of  the  head  and  the  tuberosities,  the  anatomical 
neck  lying  between  the  two,  and  the  surgical  neck 
being  the  constricted  portion  of  the  shaft  just  below 
the  tuberosities;  the  surgical  neck  is  so  called  because 
it  is  the  part  most  frequently  broken. 

The  lower  end  of  the  humerus  is  expanded  to  form 
the  elbow  joint  and  has  a  projection  on  each  side 
known  as  a  condyle. 

The  elbow  joint  is  made  up  of  the  humerus  and  the 
two  bones  of  the  forearm,  the  radius 
and  ulna  (Fig.  13). 

The  radius  lies  on  the  outer  side  of 
the  arm  and  is  so  called  because  it 
radiates  about  its  fellow  in  the  mo- 
tion of  pronation,  in  which  the  palm 
of  the  hand  is  turned  down,  and 
supination,  in  which  the  palm  is 
turned  up.  The  radius  has  a  small 
head  which  takes  but  little  part  in  the 
elbow  joint,  but  a  large  lower  end 
which  with  the  carpus  forms  the  wrist 
joint  to  the  entire  exclusion  of  the 
ulna.  It  is  because  of  the  radius  resisting  almost 
alone  the  force  of  falls  upon  the  hand  that  it  is 
broken  so  much  more  often  than  the  ulna.  Such  a 
break  just  above  the  wrist  joint  is  very  common 
and  is  known  as  a  "  Colles's  fracture." 

The  ulna  has  its  upper  end  most  highly  developed, 
forming  a  projection  which  extends  back  behind  the 
elbow  joint,  protecting  it  in  the  same  manner  as  the 
patella  does  the  knee  joint.    This  protection  forms  ^  13 —Radius  and 
the  "  point  of  the  elbow  "  and  is  called  the  olecranon. 


Fig.  12. —  Hu- 
merus. 


Ulna. 


THE  SKELETON  AND  JOINTS 


45 


The  wrist  or  carpus  is  composed  of  eight  small  bones  in  two 
rows  of  four  each,  the  upper  row  together  with  the  lower  end  of 
the  radius  forming  the  wrist  joint.  The  hand  is  composed  of  the 
five  metacarpal  bones,  while  the  fingers  have  three  rows  of  phalanges, 
except  the  thumb  which  has  two  only. 

Balanced  on  the  top  of  the  spinal  column  and  forming  a  joint  with 
its  uppermost  vertebra  is  the  skull  (Fig.  14).  The  skull  is  usually 
considered  in  two  parts, 
the  cranium  which  con- 
tains the  brain,  and  the 
face.  The  cranium  is  that 
part  which  lies  above  a 
line  drawn  from  the  nape 
of  the  neck  through  the 
ears  to  above  the  eyebrows, 
and  the  brain  here  lies 
everywhere  in  contact  with 
the  bone  so  that  a  fracture 
of  the  cranium  like  one  of 
the  spine,  derives  its  spe- 
cial seriousness  from  the 
accompanying  injury  to  the 
brain.  In  front,  however, 
just  over  the  eyes,  the  two 
plates  of  which  the  cranial 
bones  "are  composed  separate  to  leave  a  space  known  as  the  frontal 
sinuses;  here  fractures  of  the  outer  plate  may  occur  without  injury 
to  the  brain.  The  cranium  varies  in  thickness  from  about  that  of 
paper  at  the  temples  to  a  quarter  of  an  inch  or  more  behind. 

The  visible  portion  of  the  cranium  is  composed  of  six  bones,  the 
frontal  in  front,  the  occipital  behind,  the  two  parietals  on  the  top,  and 
the  two  temporals  on  the  sides.  In  the  lower  part  of  the  occipital 
bone  is  a  large  round  hole  known  as  the  foramen  magnum  through 
which  the  spinal  cord  makes  connection  with  the  brain. 

The  face  is  composed  of  fourteen  bones,  arranged  mostly  in  pairs, 
and  forming  the  two  orbits,  the  nose,  and  mouth.  The  only  facial 
bones  necessary  to  remember  are  the  two,  tiny,  nasal  bones  which 
form  the  arch  of  the  nose,  and  the  two  superior  maxillary  hones  and 


Fig.  14. —  Skull,  a.  Nasal  bones;  h,  superior 
maxilla;  c,  inferior  maxilla;  d,  occipital  bone; 
e,  temporal  bone;  /,  parietal  bone;  g,  frontal  bone. 


46 


ANATOMY  AND  PHYSIOLOGY 


the  inferior  maxillary  bone  which  contain  the  teeth  and  enclose  the 

mouth. 

The  inferior  maxillary  is  the  only  movable  bone  of  the  face;  its 

joints  with  the  upper  jaw  lie  just  in  front  of  the  ear  where  the  head 

of  the  bone  can  be  felt  to  move  when  the  mouth  is  opened. 

The  teeth  appear  in  two  crops ;  the  first,  ten  in  number  in  each 

jaw,  are  known  as  the  milk  teeth;  at  the  end  of  the  sixth  year  they 
begin  to  be  replaced  by  the  permanent  teeth,  six- 
teen in  each  jaw.  The  second  dentition  is  not 
concluded  until  about  the  twenty-first  year  when 
the  wisdom  teeth  or  last  molars  appear. 

Every  tooth  has  a  erozvn  the  part  above  the 
gum,  a  neck,  the  constricted  portion  just  below 
the  crown,  and  a  root,  the  part  embedded  in  the 
jaw.  In  structure  (Fig.  15)  they  are  composed 
of  enamel,  the  hard  surface  covering,  the  dentine 
which  comprises  the  mass  of  the  tooth,  the  cement 
which  covers  the  root,  and  the  pulp  composed 

of  nerves  and  blood-vessels  which  nourishes  the  tooth  and  lies  in  its 

interior.    When  the  teeth  are  not  properly  cared  for  the  protective 


Fig.  15. — Section  of 
Lower  Molar,  a.  Den- 
tine; b,  enamel;  c, 
crusta  petrosa;  d,  pulp 
cavity. 


Canine  or  Eye 
Tooth  of  Upper 
Jaw. 


Second  Bicus- 
pid of  Lower 
Jaw. 


Central    Incisor 
of  Upper  Jaw. 

Fig.  16. 


Second  Molar  of 
Upper  Jaw. 


Wisdom    Tooth 
of  Upper  Jaw. 


enamel  cover  breaks  down,  exposing  the  detine  which  rapidly 
decays,  undermining  the  enamel  and  finally  exposing  the  sensitive 
pulp;  pain  then  begins,  and  unless  the  tooth  is  filled  death  of  the 
pulp  occurs  and  the  tooth  is  lost. 

The  four  front  teeth  in  each  jaw  are  adapted  to  cutting  and  are 
called  incisors;  next  to  these  on  each  side  is  a  tearer  or  canine  tooth, 
and  then  two  bicuspids;  all  of  these  usually  have  a  single  root.  After 
the  bicuspids  come  three  molars  or  grinders  on  each  side.     The  up- 


THE  SKELETON  AND  JOINTS  47 

per  molars  usually  have  three  roots,  two  on  the  outer  side  and  one 
on  the  inner,  while  the  lower  molars  generally  have  two  roots.  A 
knowledge  of  the  number  and  arrangement  of  the  roots  of  the  teeth 
is  necessary  in  order  to  select  the  proper  pair  of  forceps  to  use  in 
tooth  extraction  (Fig.  i6). 


CHAPTER   II 


THE  MUSCLES,   CELLULAR  TISSUE,   AND  THE  SKIN 

Muscles  are  simply  lean  meat.    Each  muscle  is  composed  of  a 
number  of  fibers  held  together  by  connective  tissue,  and  collected 
into  bundles  which  are  enclosed  in  a  sheath  of  fibrous  tissue  known 
as  fascia. 

The  function  of  muscles  is  to  contract  and  thereby 
move  the  various  parts  and  tissues  of  the  body; 
their  tendency  to  contract  is  constantly  present  dur- 
ing life,  so  that  if  a  muscle  is  cut  the  two  ends  at 
once  pull  apart  and  a  gaping  wound  is  left.  Foi 
the  same  reason  if  a  bone  is  broken  the  contracting 
muscles  on  each  side  of  the  fracture  have  a  tendency 
to  shorten  the  limb,  making  the  ends  of  the  bone 
override  each  other  and  produce  deformity  (Fig. 
17).  It  is  this  muscular  contraction  which  must  be 
overcome  in  setting  fractures  or  reducing  disloca- 
tions. 

As  muscles  taper  toward  the  ends  they  become 
more  and  more  fibrous  until  white,  glistening  ten- 
dons or  sinezus  are  formed  which  finally  blend  with 
the  periosteum  at  the  point  of  attachment  to'  bone. 
Most  muscles,  like  those  of  the  limbs,  are  under 
the  control  of  the  will  and  are  known  as  voluntary 
muscles  (Fig.  18),  while  others,  like  those  of  the 
heart  and  intestinal  tract,  are  entirely  involuntary. 
This  involuntary  action  of  the  important  muscles 
of  Thtgh.^*'Dffo^rm'i[y  which  prcsidc  over  the  necessary  functions  of  life 
tio^    '""scuiar    ac-  jg  ^  ^j^^  provision  of  nature;  otherwise  one  might 
forget  to  breathe  or  make  the  heart  beat,  and  sleep 
would  be  out  of  the  question. 

The  muscles  in  their  action  upon  the  bones  produce  various 
special  motions;  bending  a  limb  is  called  flexion,  straightening  it  is 
extension;  turning  the  palm  down  is  pronation,  turning  it  up  supi- 

(48) 


MUSCLES,  CELLULAR  TISSUE  AND  SKIN 


49 


nation;  motion  of  the  limb  on  its  long  axis  is  rotation.  Abduction  is 
throwing  a  limb  out  from  the  body,  while  drawing  it  toward  the 
body  is  adduction. 


Fig.   i8. —  Superficial  Layer  of  Voluntary  Muscles. 

In  a  variable  time  after  death  rigor  mortis  sets  in,  a  change  in  the 
muscles  by  which  they  become  rigid,  and  remain  so  until  decomposi- 
tion begins.     When  the  person  has  undergone  great  muscular  exer- 


50  ANATOMY  AND  PHYSIOLOGY 

tion  to  the  point  of  exhaustion  just  before  death  this  change  takes 
place  almost  immediately,  so  that  the  soldier  killed  in  battle  may  be 
found  rigidly  fixed  in  the  same  position  in  which  he  met  his  death. 

The  only  \oluntary  muscles  which  it  is  necessary  for  you  to  re- 
member arc  the  stcrno-mastoid,  the  biceps,  and  the  diaphragm.  Im- 
portant involuntary  muscles  are  the  heart,  stomach,  and  bladder. 

The  stcrno-mastoid  is  the  prominent  muscle  seen  on  each  side  of 
the  neck  when  the  head  is  turned  in  the  opposite  direction  and  ex- 
tending from  behind  the  ear  to  the  top  of  the  sternum ;  its  front  edge 
is  a  guide  to  the  carotid  artery.  The  biceps  is  the  big  muscle  on  the 
front  of  the  arm,  familiar  to  all,  and  the  inner  border  of  which  is  a 
guide  to  the  brachial  artery. 

The  diaphragm  is  the  great  muscular  partition  between  the  thorax 
and  abdomen. 

The  connective  or  cellular  tissue,  so  called  because  of  the  spaces 
contained  in  its  spongy  structure,  connects  together  all  the  other 
special  tissues,  and  serves  as  a  support  for  the  blood-vessels,  nerves, 
and  fat. 

The  fat  is  the  padding  which  fills  in  empty  spaces  and  gives  form 
and  pleasing  outlines  to  the  body.  Its  important  functions  are  to 
serve  as  a  reserve  of  nutritive  material  for  emergencies,  and  to  act 
as  a  blanket  in  retaining  the  bodily  heat.  The  emaciation  which 
follows  an  exhausting  illness  is  largely  due  to  the  using  up  of  the 
reserve  fat,  and  everyone  is  familiar  with  the  fact  that  a  fat  person 
stands  cold  better  and  heat  less  well  than  a  thin  one. 

The  skin  is  a  tough,  elastic  membrane  which  covers  the  entire 
body  and  is  continuous  at  the  various  orifices  with  the  mucous 
membrane.  Anatomically  it  consists  of  two  layers,  the  cuticle,  and 
the  derma  or  true  skin.  The  cuticle  is  that  part  which  is  raised  when 
a  blister  occurs  and  which  peels  off  after  scarlet  fever. 

The  derma  constitutes  the  greater  part  of  the  thickness  of  the 
skin,  and  contains  the  blood-vessels,  nerves,  sabaceous  and  sweat 
glands. 

The  appendages  of  the  skin  are  the  hair  and  the  nails  which  arc 
modified  cuticle  (Fig.  19). 

The  sebaceous  glands  secrete  an  oily  substance  which  gives  to  the 
skin  its  softness  and  pliability ;  the  orifices  of  the  ducts  of  the  se- 
baceous glands  are  particularly  large  about  the  face  and  nose,  and 
when  plugged  with  dirt  form  the  familiar  black-heads. 


MUSCLES,  CELLULAR  TISSUE  AND  SKIN 


51 


fhe  sweat  glands  are  in  vast  numbers  all  over  the  body  and  their 
orifices  constitute  what  are  known  as  the  pores.  They  secrete  a 
variable  amount  of  water,  averaging  about  two  pints  a  day,  and  the 
water  contains  organic  matter  and  salts,  and  constitutes  the  perspira- 
tion or  sweat. 

The  functions  of  the  skin  are  to  protect  the  underlying  parts  from 
injury,  from  the  invasion  of  bacteria,  and  from  undue  evaporation  ; 


Fig.  19.  —  Perpendicular  Section  of  the  Skin,  showing:  a,  The  epidermis,  cuticle,  or  icarf 
skin;  b,  a  layer  of  dark-colored  cells;  c,  the  papillae  on  the  surface  of  d,  the  corium,  derma, 
cutis  vera,  or  true  skin,  and  e,  the  fat  cells  underlying  it;  /,  a  perspiratory  pore  or  aper- 
ture, g,  the  duct,  and  h,  the  coiled  substance  of  a  sudoriparous  gland;  »,  the  shaft  of  a  hair, 
k,  its  root,  and  /,  sebaceous  glands  communicating  with  the  interior  of  the  hair  follicle. 

to  receive  the  nerve  ends  and  thereby  serve  as  a  special  organ  of 
touch ;  and  through  the  agency  of  the  sweat  glands  to  act  as  an  im- 
portant excretory  apparatus  and  a  regulator  of  bodily  temperature. 

The  importance  of  a  whole  skin  as  a  protection  against  the  bacteria 
of  disease  is  well  known ;  subcutaneous  wounds,  that  is,  contusions, 
give  us  little  anxiety,  but  if  the  skin  is  broken  special  dressings  must 
be  applied  to  take  its  place.  Plague  frequently  invades  the  body 
through  a  break  in  the  protective  wall  of  the  skin  and  syphilis  is 
contracted  in  the  same  manner. 

The  excretory  function  of  the  skin,  by  which  it  throws  off  poison- 
ous waste  products  dissolved  in  the  perspiration,  is  illustrated  by 
what  happens  in  extensive  superficial  burns  by  which  this  function 
of  the  skin  is  destroyed;  the  man  becomes  poisoned  by  his  own 
waste  products  and  death  is  the  result. 


52  ANATOMY  AND  PHYSIOLOGY 

As  a  temperature  regulator  its  action  is  shown  by  the  increased 
perspiration  in  hot  weather,  the  evaporation  of  the  water  serving  to 
cool  the  body;  conversely  in  winter  perspiration  is  imperceptible. 

The  skin  has  also  absorbing  powers;  thirst  may  be  allayed  by 
prolonged  immersion  in  a  bath ;  the  vapor  of  mercury  and  even 
metallic  mercury  may  be  taken  up  through  the  unbroken  skin. 


CHAPTER   III 

THE    NERVOUS    SYSTEM    AND    SPECIAL    SENSES 

The  nervous  system  consists  of  the  brain,  spinal  cord,  and  the 
nerves  constituting  the  cerebrospinal  system,  and  the  ganglia  and 
connecting  nerves  composing  the  sympathetic  system. 

The  brain  situated  within  the  cranium  is  the  steat  of  the  intellect 
and  will,  and  the  great  headquarters  telegraph  office  from  which  all 
the  orders  for  motion  are  sent  out  and  to  which  all  the  reports  called 
sensations  are  forwarded.  The  spinal  cord  extends  downward  from 
the  brain  through  the  spinal  canal  and  is  largely  an  aggregation  of 
nerves  or  wires  connecting  the  brain  with  all  parts  of  the  body. 
The  ganglia  (Fig.  20)  are  small  masses  of  nervous  matter  arranged 
in  pairs  along  the  spinal  column  and  in  groups  about  the  heart  and 
great  viscera;  they  are  connected  with  each  other  and  with  the 
cerebro-spinal  system,  and  their  distribution  is  to  the  heart,  lungs, 
blood-vessels,  the  gastro-intestinal  tract,  and  the  great  viscera. 

The  nerves  are  composed  of  bundles  of  minute  tubules  enclosed 
in  a  protective  sheath,  each  of  these  tubules  corresponding  to  a  tele^ 
graph  wire  and  ultimately  reaching  its  destination  without  branching. 

The  brain  (Fig.  21)  consists  of  the  cerebrum  and  cerebellum,  and 
pons  and  medulla.  The  cerebrum  is  the  soft,  pulpy,  oval  mass  which 
is  seen  when  the  top  of  the  cranium  is  removed ;  it  is  divided  from 
before  backward  by  a  deep  fissure,  almost,  but  not  quite  complete, 
so  that  there  is  a  bridge  left  connecting  the  two  halves. 

The  surface  of  the  brain  presents  numerous  grooves  or  sulci,  be- 
tween which  are  the  convolutions.  The  exterior  is  composed  of  gray 
matter,  and  the  interior  of  zchite  matter,  the  latter  being  nothing 
more  than  a  collection  of  nerves  connecting  the  various  parts  of  the 
brain  with  each  other  and  with  the  spinal  cord.  In  the  interior  of 
the  cerebrum  are  a  number  of  cavities  known  as  v^ttricles.  The 
gray  matter  is  the  seat  of  the  mind. 

The  brain  is  very  delicate  and  easily  injured;  injuries  or  even 
slight  pressure  seriously  interfere  with  its  functions.     So  when  a 

(53) 


54 


ANATOMY  AND  PHYSIOLOGY 


fracture  of  the  skull  occurs  with  depression  of  bone,  or  even  a  slight 
bleeding  from  one  of  the  cerebral  vessels,  pressure  on  the  brain 


Fig.  20.  —  Sympathetic  System  of  Ganglia  and  Nerves. 

results  and  we  have  unconsciousness  or  paralysis  or  both ;  this  is 
the  condition  in  apoplexy  which  is  merely  a  hemorrhage  within  the 
cranium ;  as  the  blood  cannot  escape  it  must  produce  pressure. 


THE  NERVOUS  SYSTEM  AND  SPECIAL  SENSES    55 

Lining  the  interior  of  the  cranium  is  a  strong  fibrous  membrane 
which  protects  and  suspends  the  brain  and  is  called  the  dura  mater; 
this  with  the  pia  mater  and  arachnoid  constitute  the  meninges  or 
membranes,  inflammation  of  which  is  known  as  meningitis. 

If  we  lift  up  the  back  part  of  the  cerebrum  we  see  below  it  a 
small  mass  of  nervous  tissue  known  as  the  cerebellum  or  little  brain 
(Fig.  22).  It  is  chiefly  concerned  with  the  maintenance  of  the 
equilibrium  of  the  body. 


Fig.  21. —  The  Hemispheres  of  the  Brain.  A,  The  right;  B,  the  left  divided  from  before 
backward  by  a,  b,  the  longitudinal  fissure,  and  connected  by  c,  the  bridge  of  transverse 
fibers  called  the  corpus  callosum.  Oij  the  right  side  the  convolutions  and  sulci  are  shown; 
on  the  left  the  upper  part  of  the  convexity  of  the  hemisphere  has  been  cut  away  to  show 
the  gray  matter  d,  d,  dipping  into  the  sulci  and  appearing  as  islands,  e,  e,  in  the  interior 
of  the  white  matter;  the  elongated  cavity  with  curved  extremities  is  the  lateral  ventricle 
of  that  side. 

The  pons  is  the  connecting  link  between  the  cerebrum  and  me- 
dulla and  between  the  two  lobes  of  the  cerebellum. 

The  medulla  oblongata  is  the  enlarged  upper  end  of  the  spinal 
cord  lying  just  within  the  cranium,  and  containing  the  important 
nerve  centers  presiding  over  the  action  of  the  heart  and  lungs.  It 
is  also  the  part  in  which  the  nerves  coming  from  each  side  of  the 
brain  cross  over  to  the  opposite  side  of  the  spinal  cord,  so  that  an 
injury  of  the  brain  above  this  crossing  causes  a  paralysis  on  the 
opposite  side  of  the  body. 

The  spinal  cord  (Fig.  23),  like  the  brain,  is  enclosed  in  mem- 
branes and  is  a  tail-like  column  of  nervous  tissue  composed  chiefly 
of  nerves  but  containing  in  its  interior  a  central  column  of  gray 


56 


ANATOMY  AND  PHYSIOLOGY 


matter.  A  pair  of  nerves  leave  it  opposite  each  vertebra,  those  of 
the  cervical  region  being  arranged  in  two  groups.  The  upper  group 
suppHes  the  face  and  neck  and  the  interior  of  the  chest;  one  of  the 
most  important  of  the  branches  is  the  phrenic,  which  controls  the 
movements  of  the  diaphragm.  The  lower  group  is  known  as  the 
brachial  plexus  and  supplies  the  upper  extremity. 


Fig.  22.  —  Lower  Surface  of  Brain.     C,  Cerebellum;  M,  medulla;  P,  pons. 

The  dorsal  nerves  supply  the  chest  wall,  those  of  the  lumbar  and 
sacral  regions  go  to  the  pelvis  and  lower  extremities ;  one  great  cord 
which  emerges  from  the  pelvis  on  each  side  and  passes  down  the 
back  of  the  thigh  is  called  the  sciatic  nerve;  it  is  often  the  seat  of 
the  neuralgic  pain  known  as  sciatica. 

As  all  the  nerves  of  the  body  except  those  of  the  face  must  pass 
through  the  spinal  cord  on  their  way  to  the  brain  it  is  evident  that  if 
the  spinal  cord  is  cut  completely  across  there  must  be  paralysis  of  all 
the  parts  below;  such  a  paralysis  is  called  paraplegia.  If  the  injury 
is  high  enough  up  the  nerves  controlling  the  action  of  the  heart  and 


THE  NERVOUS  SYSTEM  AND  SPECIAL  SENSES    57 


lungs  are  involved  and  death  quickly  follows.  As  the  motor  nerves 
are  collected  in  the  front  part  of  the  spinal  cord  and  the  sensory 
nerves  in  the  back  part,  a 
partial  injury  of  the  cord 
may  cause  paralysis  of  mo- 
tion without  affecting  sen- 
sation, or  vice  versa. 

There  are  two  kinds  of 
nerve  tubules,  motor  and 
sensory.  The  former  con- 
vey from  the  brain  orders 
directing  motion,  while  the 
latter  carry  to  the  brain  in- 
formation as  to  sensation. 
If  a  motor  nerve  is  cut  the 
muscles  supplied  by  it  are 
paralyzed  because  orders 
from  the  brain  can  no 
longer  reach  them;  if  a 
sensory  nerve  is  cut  sensa- 
tion is  lost  in  the  part  sup- 
plied by  it  because  infor- 
mation as  to  the  sensory 
condition  of  the  part  can 
no  longer  reach  the  brain. 
Usually  nerves  contain  both 
motor  and  sensory  fibers, 
but  some  nerves,  like  the 
facial,  are  purely  motor. 

There  are  certain  reports 
and  impressions  which  are 
sent  by  way  of  the  nerves 
from  various  parts  of  the 

body  which  it  is  not  neces-  Fig.  23.  —  Spinal  Cord  and  Nerves. 

sary  to  refer  to  the  brain  for  its  action ;  the  necessary  action  is  pro- 
vided automatically  by  what  is  called  reflex  action. 


58 


ANATOMY  AND  PHYSIOLOGY 


•  Section  of  Nose. 
nerves. 


Olfactory 


The  quick  withdrawal  of  the  hand  when  it  touches  something 
hot  and  the  rhythmical  contraction  of  the  heart  under  the  stimulus 
of  its;  distention  with  blood  are  instances  of  reflex  or  automatic 

action  originating  respectively  in 
the  gray  matter  of  the  spinal  cord 
and  ganglia. 

The  special  senses  are  touch, 
taste,  smell,  hearing,  and  sight. 
The  three  latter  are  presided  over 
by  special  cranial  nerves,  that  is, 
nerves  coming  directly  from  the 
brain  without  passing  through  the 
spinal  cord. 

The  sense  of  touch  is  resident  in 
the  skin  generally,  but  is  most 
highly  developed  in  the  ends  of  the 
fingers. 

The  sense  of  taste  is  located  in  the  mouth,  more  especially  in  the 
tongue;  for  its  action  it  is  necessary  that  the  substance  should  be 
in  solution ;  this  is  in*  accordance  with  our  knowledge  that  insoluble 
medicines  are  tasteless. 

The  sense  of 
smell  resides  in  the 
upper  nasal  cavi- 
ties where  the  fila- 
ments of  the  olfac- 
tory nerve  are  dis- 
tributed to  the 
mucous  membrane 
(Fig.  24). 

Hearing  or  the 
perception  of 
sound  vibrations  is 
provided  for  by 
the  ear  through 
the  auditory  nerve.  "^^^  v      Ci 

The   ear    (big.    25)fig.  25.  —  Section  of  the  Ear.     5,  External  ear;  ikf,  auditory  canal; 
ronsists    of   the    ex-       7",  tympanum;  P,  middle  ear;  H,  ossicles;  £,  Eustachian  tube. 


THE  NERVOUS  SYSTEM  AND  SPECIAL  SENSES    59 

ternal  ear,  the  auditory  canal,  the  tympanum  or  drum  membrane, 
the  middle  ear,  stretching  across  which  are  the  small  bones  or 
ossicles,  and  the  internal  ear.  The  tympanum  is  stretched  like 
a  drum-head  across  the  auditory  canal,  separating  the  external  and 
middle  ears ;  in  order  that  the  air  pressure  on  the  two  sides  of  the 
drum  may  be  equaHzed  there  is  an  air  tube  leading  from  the  middle 
ear  to  the  throat  and  known  as  the  Eustachian  tube;  stoppage  of  this 
tube  in  chronic  inflammation  of  the  throat  is  one  of  the  causes  of 
deafness. 


Fig.  26.  —  Section  of  the  Eye.     i,  Conjunctiva;  2,  cornea;  3,3,  iris;  4,  pupil;   5,  lens; 
6,  retina;  7,  optic  nerve. 

The  sense  of  sight  consists  in  the  perception  of  light,  color,  form, 
size,  and  distance ;   it  is  resident  in  the  eye. 

The  eye  (Fig.  26)  is  situated  in  the  orbit,  the  projecting  upper 
border  of  which,  together  with  the  quickly  moving  lids,  give  it  pro- 
tection. It  is  covered  in  front  by  a  thin  vascular  membrane  which 
also  lines  the  lids  and  is  known  as  the  conjunctiva.  Light  enters 
through  the  transparent  cornea  which  is  set  in  front  of  the  eye  like 
a  watch-glass ;  behind  the  cornea  is  hung  a  curtain  of  muscular  fibers 
variously  colored  and  called  the  iris;  the  black  pupil  is  really  a  hole 
in  the  iris  to  let  in  the  light  which  then  passes  through  a  crystalline 
lens  just  behind  the  pupil  and  is  brought  to  a  focus  on  the  retina;  the 


60  ANATOMY  AND  PHYSIOLOGY 

retina  is  merely  an  expansion  of  the  optic  nerve  which  transmits  the 
luminous  impressions  to  the  brain.  The  dense  white  outer  coat  of 
the  eye,  lying  beneath  the  conjunctiva,  is  known  as  the  sclerotic. 

The  eye  is  a  camera,  focusing  being  accomplished  by  changes  in 
the  convexity  of  the  lens  effected  by  the  contraction  of  the  ciliary 
muscle,  the  muscle  of  accommodation. 

Color-blindness  is  the  inability  to  distinguish  certam  colors,  par- 
ticularly reds  and  greens. 


CHAPTER  IV 

THE   DIGESTIVE  APPARATUS 

Inasmuch  as  the  nutritive  constitutents  of  the  blood  are  being 
constantly  used  up  in  the  repair  of  tissue  and  the  production  of  heat 
and  force,  it  is  necessary  that  some  provision  should  be  made  for  a 
constant  supply  of  new  material.  This  is  done  by  the  food  through 
the  digestive  apparatus ;  the  function  of  the  digestion  is  to  prepare 
the  food  for  absorption  and  nutrition. 

Foods  are  usually  classified  according  to  certain  definite  com- 
pounds or  alimentary  principles  which  they  contain ;  these  are  four 
in  number:  i.  Albuminates,  nitrogenous  substances  or  proteids; 
2.  Fats  or  hydrocarbons ;  3.  Starches  and  sugars  or  carbohydrates; 
4.  Minerals,  including  water  and  salts. 

The  especial  uses  of  these  alimentary  principles  in  nutrition  are  as 
follows :  The  albuminates  are  essential  for  the  repair  of  all  the 
nitrogenous  constituents  of  the  body,  that  is  to  say,  they  are  muscle 
and  blood  builders ;  they  regulate  the  absorption  and  use  of  oxygen ; 
they  sometimes  form  fat,  and  hence  force  and  heat.  The  fats 
produce  force  and  heat,  prevent  the  waste  of  the  nitrogenous  tissues, 
and  serve  as  a  reserve  of  heat  and  force.  The  starches  and  sugars 
also  are  readily  convertible  into  heat  and  work,  and,  though  they 
have  little  part  in  the  composition  of  the  tissues  of  the  body,  they 
contribute  directly  or  indirectly  to  the  deposit  of  fat.  Water  con- 
stitutes nearly  60  per  cent  of  the  human  body  and  is  the  most  im- 
portant constituent  of  foods ;  without  the  other  foods  one  may  live 
weeks,  but  without  water  it  is  a  question  of  a  very  few  days.  Water 
is  the  great  solvent  without  which  even  the  circulation  of  the  blood 
can  not  go  on. 

The  various  salts  are  also  essential ;  the  alkaline  carbonates  formed 
from  the  salt^  of  the  vegetable  acids  maintain  the  necessary  alka- 
linity of  the  blood  and  body  fluids ;  without  a  due  proportion  of  them 
scurvy  occurs. 

All  these  alimentary  principles  are  necessary  for  life;  some  one  or 

(61) 


62 


ANATOMY  AND  PHYSIOLOGY 


more  of  them  are  contained  in  all  foods;  if  any  one  food  contained 
them  all  in  proper  proportion  that  substance  would  constitute  a  com- 
plete diet ;  milk  contains  them  all  and  in  a  complete  form  for  infants, 
but  for  adults  a  mixed  diet  is  necessary.  Beef  consists  largely  of 
albuminates,  pork  of  fats,  bread  of  starch,  candies  of  sugar. 


Fig.  27.  —  View  of  Thoracic  and  Abdominal  Organs;  anterior  walls  removed,  but  the 
relative  position  of  the  ribs,  navel,  etc.,  indicated,  a,  Heart;  b,  great  vessels;  c,  c,  lungs; 
d,  d,  diaphragm;  e,  liver;  f,  gall  bladder;  g,  stomach;  h,  spleen;  »,  ascending  colon; 
/,  transverse  colon;  k,  coils  of  small  intestine;  /,  position  of  ileo-cecal  valve  at  junction  of 
small  and  large  intestines;  in,  urinary  bladder. 

The  proper  quantity  of  the  various  articles  of  food  necessary  per 
day  to  maintain  a  man  in  good  health  while  performing  ordinary 
labor  constitutes  a  ration. 

Great  exertion  calls  for  an  increase  of  the  albuminates  and  fats, 
while  great  cold  demands  a  special  increase  of  the  fats. 

Now  these  alimentary  principles,  in  the  form  in  which  they  exist 
in  foods,  are  not  ready  for  absorption ;  they  must  be  reduced  to 
soluble  forms :   the  albuminates  to  peptones,  the  sugars  and  starches 


THE  DIGESTIVE  APPARATUS  63 

to  glucose,  and  the  fats  to  an  emulsion ;  to  accomplish  this  Is  the 
purpose  of  the  digestive  apparatus. 

When  too  much  food  is  taken  the  excess  is  not  digested  but  acts 
as  a  foreign  body  and  causes  irritation  of  the  stomach  and  bowels, 
followed  by  pain  and  diarrhea,  or  the  poisonous  products  of  decom- 
position are  absorbed,  causing  fever  —  auto-intoxication. 

A  deficiency  of  food  causes  the  tissues  of  the  body  to  be  drawn 
upon  and  emaciation  is  the  result. 

The  apparatus  for  the  digestion  of  the  food  consists  of  the 
alimentary  canal,  and  the  salivary  glands,  liver,  spleen,  and  pancreas. 
The  alimentary  canal  includes  the  mouth,  pharynx,  oesophagus, 
stomach,  small  intestine,  and  large  intestine;  it  is  a  muscular  tube 
lined  with  mucous  membrane,  about  thirty  feet  long  and  extending 
from  the  lips  to  the  anus  (Fig.  27). 

In  the  mouth  provision  is  made  for  the  mastication  of  the  food  and 
its  admixture  with  saliva ;  beyond  this  is  the  apparatus  for  swallow- 
ing, the  pharynx  and  oesophagus,  which  convey  the  food  to  the 
stomach,  where  a  partial  reduction  and  solution  of  it  take  place;  in 
the  small  intestine  the  digestion  and  solution  are  completed,  and  the 
nutritive  principles,  composing  the  chyle,  are  separated,  by  its  admix- 
ture with  the  bile  and  pancreatic  juice,  from  that  portion  which 
passes  into  the  large  intestine,  most  of  which  is  expelled  from  the 
body. 

In  looking  into  the  mouth  (Fig.  28),  we  see  the  teeth  and  tongue, 
already  described,  and,  stretching  across  the  upper  and  back  part, 
a  fleshy  curtain  known  as  the  palate;  hanging  down  from  the  center 
of  the  palate  is  the  uvula,  and  on  either  side  behind  the  palate  are 
the  tonsils. 

In  the  mouth  the  food  is  thoroughly  broken  up  by  the  teeth  and, 
assisted  by  the  tongue,  mixed  with  the  saliva,  and  formed  into  a 
suitable  lubricated  mass  for  swallowing;  The  only  digestion  which 
takes  place  in  the  mouth  is  the  slight  conversion  of  the  .starch  into 
sugar;  nevertheless  thorough  mastication  is  of  the  greatest  impor- 
tance, as,  the  more  completely  the  food  is  broken  into  small  particles, 
the  more  easily  the  digestive  fluids  of  the  stomach  and  intestines 
get  at  the  particles  to  dissolve  them.  If  we  wish  to  dissolve  out  the 
soluble  constituents  of  a  crude  drug,  we  first  pulverize  it  in  a  mortar, 
and  the  same  principle  obtains  here. 

After  the  food  has  been  masticated  it  is  pushed  into  the  pharynx 


64  ANATOMY  AND  PHYSIOLOGY 

by  the  tongue  and  there  passes  beyond  the  control  of  the  will  through 
the  eight  or  nine  inches  of  the  oesophagus  or  gullet  into  the  stomach. 
The  saliva  comes  from  the  salivary  glands,  which  are  three  in 
number  on  each  side,  the  parotid,  submaxillary,  and  sublingual.  The 
parotid  glands  are  situated  just  in  front  of  and  below  the  ear,  and  are 


Fig.  28.  —  Section  of  Head  and  Neck. 


the  seat  of  the  inflammation  known  as  mumps.  The  other  salivary 
glands  are  placed  below  the  tongue  and  lower  jaw. 

The  stomach  (Fig.  29)  is  a  muscular  bag  lined  with  mucous  mem- 
brane, pear  shaped,  with  the  large  end  to  the  left  and  lying  on  the 
upper  part  of  the  abdomen,  largely  behind  the  ribs,  and  separated 
from  the  thoracic  cavity  by  the  diaphragm.  The  heart  is  just  above 
it,  with  only  the  diaphragm  between,  so  that  it  can  easily  be  seen  how 
distention  of  the  stomach  may  cause  disturbances  of  the  heart  and 
how  pains  in  the  stomach  are  so  often  referred  to  the  heart. 

The  stomach  opens  into  the  oesophagus  at  one  end  and  into  the 
small  intestine  at  the  other  by  small  openings  known  as  the  cardiac 


THE  DIGESTIVE  APPARATUS  65 

and  pyloric  orifices,  respectively.  The  small  intestine  is  about  twenty- 
five  feet  long,  and  lies  in  the  central  and  lower  part  of  the  abdomen, 
extending  from  the  stomach  to  the  right  groin,  where  it  terminates 
in  a  valvular  opening  into  the  large  intestine. 

The  large  intestine  is  about  five  feet  long.  It  commences  at  the 
termination  of  the  small  intestine  in  the  right  groin,  this  part  of  it 
being  known  as  the  cecum  and  having  attached  to  its  lower  and 


Fig.  29.  Stomach. 

back  part  a  tail-like  appendage  known  as  the  vermiform  appendix; 
this  appendix,  about  the  size  of  a  goose  quill  and  two  to  five  inches 
long,  is  the  part  which  is  so  frequently  inflamed,  constituting  the 
disease  called  appendicitis. 

The  cecum  as  it  passes  up  the  right  side  of  the  abdomen  is  known 
as  the  ascending  colon;  under  the  liver  it  turns  and  crosses  to  the 
left  in  front  of  the  stomach,  becoming  the  transverse  colon;  on  the 
left  side  of  the  abdomen  it  turns  downward,  the  descending  colon; 
in  the  left  groin  it  makes  a  curve  like  the  letter  S,  the  sigmoid  flexure, 
and  ends  in  the  rectum,  which  descends  to  the  right  and  backward 
to  the  anus. 

The  intestines  are  covered  with  a  smooth,  shining  membrane 
which  lines  the  abdomen  and  is  known  as  the  peritoneum;  inflam- 
mation of  this  membrance  is  called  peritonitis. 

The  omentum  is  a  sort  of  apron  made  of  a  fold  of  the  peritoneum, 
containing  much  fat,  which  lies  over  the  intestines  and  protects  them. 
The  mesentery  is  the  name  applied  to  other  folds  of  the  peritoneum 
5 


66  ANATOMY  AND  PHYSIOLOGY 

which  bind  the  intestines  loosely  to  the  abdominal  walls  behind 
them.  In  the  abdominal  walls  are  certain  weak  places  where  blood- 
vessels pass  out  of  the  cavity  and  the  intestines  have  a  tendency  to 
follow  the  vessels ;  these  places  are  the  umbilicus  or  navel,  the  in- 
guinal canal,  along  which  the  vessels  pass  to  the  testicle,  and  the 
femoral  canal,  for  those  to  the  thigh.  When  the  intestine  does  so 
escape  we  have  hernia,  umbilical,  inguinal,  or  femoral,  respectively. 


Fig  30.  —  Pancreas  in  Section  to  Show  Its  Duct. 

In  the  upper  part  of  the  abdomen,  on  the  right  side  and  extending 
somewhat  to  the  left,  we  have  the  liver  (Fig.  27)  ;  it  is  the  largest 
gland  in  the  body,  weighing  between  four  and  four  and  a  half  pounds, 
and  in  its  natural  state  lies  almost  wholly  behind  the  ribs.  The 
liver  has  two  large  lobes,  between  which  and  projecting  just  beyond 
the  ribs  is  the  gall  bladder,  which  empties  by  a  narrow  duct  into  the 
small  intestine  just  beyond  the  stomach. 

To  the  left  of  the  stomach  and  also  behind  the  ribs  is  another 
gland,  which  has  no  duct,  called  the  spleen;  it  is  dark  colored  and 
about  the  size  and  shape  of  the  hand  without  the  fingers. 

Deeply  placed  behind  the  stomach  and  extending  transversely 
across  the  abdomen  is  a  slender  tongue-shaped  gland,  the  pancreas 
or  sweetbread  (Fig.  30).  It  is  about  six  inches  long  by  three-fourths 
of  an  inch  broad,  cream  colored,  and  has  a  duct  which  terminates  in 
the  small  intestine  together  with  the  common  bile  duct. 

In  the  stomach  the  food  which  has  already  been  masticated  and 
part  of  the  starch  converted  into  glucose  by  the  action  of  the  saliva 
is  brought  into  contact  with  the  gastric  juice;  this  juice  is  a  sour 
liquid,  containing'  pepsin  and  hydrochloric  acid,  secreted  by  the 
countless  small  glands  found  in  the  mucous  lining  of  the  stomach. 
This  is  the  same  pepsin  and  hydrochloric  acid  which  are  used  outside 
the  body  to  digest  milk  and  other  albuminates.     The  contraction  of 


THE  DIGESTIVE  APPARATUS  67 

the  muscular  walls  of  the  stomach  caused  by  the  presence  of  food 
thoroughly  mixes  it  with  the  gastric  juice,  and  continues  this  churn- 
ing motion  as  long  as  the  food  remains. 

Under  this  process  albuminates  are  partially  converted  into  pep- 
tones, a  form  suitable  for  absorption,  and  part  of  these  peptones  are 
immediately  absorbed  by  the  capillaries  of  the  stomach.  The  solu- 
tion of  the  albuminous  intercellular  materials  aids  in  the  liquefaction 
of  other  food  principles,  which  pass  slowly  out  of  the  stomach  into 
the  intestine  in  the  form  of  a  whitish  fluid  known  as  chyme.  The 
process  of  stomach  digestion  requires  from  one  to  four  hours,  de- 
pending upon  the  character  of  the  food,  the  thoroughness  of  mastica- 
tion, and  other  factors.  Thus  fish  and  chicken  are  more  quickly 
digested  than  beef,  and  beef  sooner  than  veal,  baked  and  stewed 
meats  sooner  than  the  same  articles  fried. 

The  mucous  lining  of  the  small  intestine  is  thrown  into  numerous 
folds  known  as  valvulce  conniventes,  the  purpose  of  which  is  to  in- 
crease the  extent  of  surface  and  this  is  still  further  accomplished  by 
the  innumerable  villi  or  tiny  projections  which  stud  the  surface  of 
the  mucous  membrane  and  give  it  a  velvety  appearance.  There  are 
also  millions  of  small  glands  or  follicles  which  secrete  the  intestinal 
juice,  an  important  aid  to  digestion.  Beside  the  intestinal  glands 
we  have  already  seen  that  the  liver  and  pancreas  empty  their  secre- 
tion into  the  small  intestine  at  its  upper  part. 

The  functions  of  the  liver  are  many ;  the  most  important  are  the 
production  and  storage  of  sugar,  the  production  of  urea,  and  the 
secretion  of  bile.  The  bile  helps  to  emulsify  fats,  stimulates  the  in- 
testinal muscle  to  contraction,  acting  as  a  laxative,  and  is.  a  natural 
antiseptic  preventing  putrefaction  of  the  intestinal  contents.  It  is  a 
familiar  fact  that  when  bile  is  absent  from  the  intestine,  as  in  some 
forms  of  jaundice,  constipation  and  very  offensive  stools  are  apt  to 
result. 

The  pancreatic  juice  digests  all  three  classes  of  food,  albuminates 
starches  and  sugar,  and  fats. 

Unlike  the  gastric  juice,  it  is  alkaline  and  incapable  of  acting  ex- 
cept in  the  presence  of  an  alkaline  reaction. 

To  digest  foods  outside  of  the  body  we  now  use  pancreatin  and 
soda  almost  to  the  exclusion  of  pepsin  and  acid. 

Under  the  combined  influence  of  all  these  intestinal  juices  the 
chyme  is  soon  converted  into  a  milky  liquid  known  as  chyle,  and  this 


68  ANATOMY  AND  PHYSIOLOGY 

is  absorbed  by  both  the  capillaries  of  the  intestinal  tract,  whence  it 
passes  to  the  liver  through  the  portal  veins,  and  by  the  lymphatics  or 
lactcals,  another  system  of  vessels  which,  arising  in  the  villi,  passes 
through  a  number  of  lymphatic  glands  situated  in  the  mesentery  and 
known  as  the  mesenteric  glands,  to  reach  a  large  duct  known  as  the 
thoracic  duct,  which  passes  up  the  left  side  of  the  spinal  column  and 
empties  into  the  left  subclavian  vein,  just  before  its  junction  with  the 
left  internal  jugular. 

The  spleen  has  no  direct  part  in  digestion,  but  it  does  serve  in- 
directly by  acting  as  a  reservoir  for  the  storage,  in  the  intervals  of 
digestion,  of  the  additional  amount  of  blood  needed  during  digestion. 
Other  important  functions  of  the  spleen  are  the  production  of  leuco- 
cytes, the  destruction  of  erythrocytes,  and  the  production  of  uric 
acid. 

Passing  on  down  the  small  intestine,  the  intestinal  contents  become 
more  and  more  solid  by  the  absorption  of  the  liquid  chyle,  and  this 
process  is  continued  in  the  large  intestine  until  finally  the  indigestible 
residue  is  cast  out  of  the  body  as  feces. 

Some  digestion  and  absorption  do  take  place  in  the  large  in- 
testine, as  we  know  from  what  occurs  when  we  use  nutrient  enemata, 
but  the  action  is  not  a  powerful  one,  and  it  is  safer  to  give  the 
enemata  predigested. 

When  digestion  is  incomplete  from  any  cause,  putrefactive  changes 
may  occur  in  the  undigested  portion  of  food  and  the  poisons  result- 
ing therefrom  may  be  absorbed,  giving  rise  to  fever,  headache,  and 
other  symptoms  of  auto-intoxication. 


CHAPTER  V 

THE  BLOOD   AND   THE    CIRCULATORY   SYSTEM 

The  circulatory  system  includes  the  lymphatic  system  and  the 
blood-vessel  system. 

The  lymphatic  system,  or  absorbent  system  (Fig.  31),  includes  the 
lymphatic  and  lacteal  vessels,  and  the  lymphatic  glands. 


Fig.  31.  —Lymphatic  System  of  Trunk,  Genitals,  and  Upper  Arm. 

(69) 


70 


ANATOMY  AND  PHYSIOLOGY 


The  lymphatic  vessels  are  found  in  all  parts  of  the  body,  wherever 
there  are  blood-vessels ;  they  contain  lymph,  a  colorless  fluid  like 
water,  except  those  of  the  intestine,  which  during  digestion  contain  a 
milky  fluid,  which  gives  to  these  particular  lymphatics  the  name  of 


Fig.  32.  —  Thoracic  Duct. 

lacteals.  All  over  the  body  also  are  found  lymphatic  glands,  varying 
in  size  from  a  pin  head  to  a  small  almond;  all  the  lymph  passes 
through  these  glands  before  it  reaches  the  blood  by  way  of  the 
thoracic  (Fig.  32)  and  lymphatic  ducts.  The  lymphatic  system  has 
an  important  function  in  connection  with  the  elaboration  of  the  blood. 


THE  BLOOD  AND  THE  CIRCULATORY  SYSTEM    71- 

more  and  more  blood  cells  appearing  in  the  lymph  as  it  passes 
through  successive  chains  of  glands. 

The  glands  also  serv^e  a  very  useful  purpose  in  resisting  the  in- 
vasion of  the  body  by  disease  germs. 

In  the  case  of  an  infected  finger  wound,  for  instance,  one  some- 
times sees  fine  red  lines  running  up  the  arm  and  the  patient  complains 
of  a  kernel  in  the  arm-pit ;  the  red  lines  are  inflamed  lymphatics  and 
the  kernel  is  an  inflamed  gland ;  again,  in  the  case  of  a  sore  on  the 
penis  the  glands  in  the  groin  swell,  constituting  a  buho. 

Certain  groups  of  lymphatic  glands  are  impor- 
tant owing  to  their  connection  with  special  diseases. 

A  characteristic  of  syphilis  is  an  enlargement  of 
the  inguinal,  epitrochlear,  and  post-cervical  glands, 
found   respectively   in   the  groin,   just   above   and  ^ 

behind  the  inner  elbow,  and  at  the  junction  of  the  ^ 

neck  with  the  back  of  the  head.  Fic  33.-0,  b,  c, 

The  inguinal  glands  also  become  inflamed  in  other  edge,  in  Rouleaux,* 
venereal  diseases.     The  glands  in  the  front  of  the  cells.     '    '  ' 
neck  become  enlarged,  cheesy,  and  sometimes  suppurating  in  the 
condition  commonly  called  scrofula,  really  a  tuberculous  invasion 
through  the  mouth. 

The  functions  of  the  blood  and  hlood-vascular  system  are  to  re- 
ceive from  the  lungs  and  alimentary  tract  and  to  carry  to  all  parts 
of  the  body  the  materials  necessary  for  its  nutrition  and  proper 
temperature  and  moisture,  and  to  carry  away  to  the  excretory  organs 
the  waste  matters  which  if  retained  would  prove  poisonous.  It  has 
also  important  functions  in  the  protection  of  the  body  from  the 
invasion  of  the  bacteria  of  disease. 

The  total  quantity  of  blood  is  usually  estimated  at  one-twelfth  of 
the  weight  of  the  body,  or  an  average  of  about  a  gallon  and  a  half. 

The  blood  is  red  in  color,  bright  red  in  the  arteries,  dark  red  in  the 
veins.  It  is  composed  of  cells  or  corpuscles  floating  in  a  liquid,  the 
liquor  sanguinis. 

The  cells  are  of  two  sorts,  the  red  cells  or  erythrocytes  and  the 
white  cells  or  leucocytes  (Fig.  33).  The  red  cells  are  much  the  more 
numerous,  there  being  about  five  hundred  times  as  many  as  there  are 
of  the  white.  They  are  very  small,  about  one-three-thousandth  of  an 
inch  in  diameter,  and,  though  red  in  mass,  the  individual  cells  are 


72  ANATOMY  AND  PHYSIOLOGY 

seen  under  the  microscope  to  be  light  yellow  in  color.  They  are 
round,  flattened  discs,  like  a  copper  cent,  except  that  they  are  con- 
cave on  each  side,  and  are  largely  composed  of  hemoglobin,  a  sub- 
stance which  has  a  great  oxygen-carrying  capacity. 

The  leucocytes  are  not  flat  like  a  cent,  but  spherical  like  a  ball,  a 
little  larger  than  the  red  cells,  composed  of  protoplasm,  and  capable 
of  changing  their  own  form  and  of  making  their  way  through  the 
unbroken  walls  of  the  blood-vessels. 

The  liquor  sanguinis  consists  of  serum  and  the  elements  of  fibrin; 
when  bleeding  occurs  the  fibrin  at  once  forms  and  the  blood  coagu- 
lates or  clots;  but  for  this  property  of  the  blood  hemorrhages  would 
never  stop. 

Serum,  which  is  liquor  sanguinis  less  fibrin,  contains  the  principal 
nourishing  ingredients  of  blood  —  albumin,  fats,  sugar,  salts,  and 
gases. 

In  a  general  way  the  blood  current  may  be  likened  to  a  river  and 
the  cells  to  boats  floating  upon  it ;  the  red  cells  are  the  freight  boats 
loaded  with  oxygen  which  they  receive  in  the  lungs  and  carry  to  all 
parts  of  the  body ;  the  white  cells  are  the  war  ships,  always  on  the 
alert  for  an  attack  by  disease  germs ;  when  such  an  attack  occurs  the 
leucocytes  hurry  to  the  invaded  point  and  a  battle  ensues  in  which 
there  are  killed  and  wounded  on  both  sides ;  the  dead  white  cells, 
when  in  large  number,  constitute  pus  or  matter.  The  blood  serum 
itself  not  only  carries  nourishment  to  all  parts  of  the  body,  but,  com- 
ing back,  acts  as  a  sewer,  bringing  away  the  waste  products,  both 
liquid  and  gaseous. 

In  order  to  maintain  a  constant  circulation  of  the  blood,  a  com- 
plete system  exists,  consisting  of  a  constantly  acting  pump,  the  heart, 
the  arteries  which  carry  the  pure  blood  to  all  parts  of  the  body,  the 
capillaries  from  which  the  blood  delivers  its  nutritive  materials  to 
the  tissues  and  takes  on  a  load  of  waste  products,  and  the  veins  which 
return  the  impure  blood  to  the  right  side  of  the  heart ;  this  is  the 
systemic  circulation  and  requires  about  a  half  a  minute  for  the  en- 
tire trip;  then  there  is  a  subsidiary  system  known  as  the  pulmonary 
circulation,  whose  arteries  take  the  impure  blood  from  the  right  side 
of  the  heart  to  the  lungs,  in  the  capillaries  of  which  it  is  purified, 
losing  carbonic  acid  and  waste  matters,  taking  on  a  load  of  oxygen, 
and  then  passing  through  the  pulmonary  veins  to  the  left  side  of  the 
heart  for  another  trip  through  the  systemic  circulation  (Fig.  34). 


THE  BLOOD  AND  THE  CIRCULATORY  SYSTEM    7Z 

The  heart  is  a  conical  hollow  muscle,  situated  between  the  lungs 
and  behind  the  sternum  and  enclosed  in  a  fibrous  sack,  the  pericar- 
dium (Fig.  35).  It  is  about  the  size  of  a  closed  fist,  its  average 
weight  being  three-fourths  of  a  pound.  The  apex  is  found  between 
the  fifth  and  sixth  ribs,  just  inside  of  the  nipple  line.     It  is  divided 


Fig.  35. — The  Thoracic  Organs,  a,  Right  lung  divided  into  three  lobes,  and  h,  left 
lung  into  two  lobes,  their  anterior  margins  thrown  back  to  expose  the  deeper  parts; 
c,  trachea,  with  its  cartilaginous  rings;  d,  right  bronchial  tube;  e,  right  auricle,  receiving 
from  above,  /,  the  superior  vena  cava,  which  is  formed  by  the  junction  of  g,  g,  the  right 
and  left  innominate  veins,  and  each  of  these  by  the  confluence  of  h,  h,  i,  i,  the  jugular 
and  subclavian  of  its  own  side;  /,  the  right  ventricle,  giving  issue  to  k,  the  pulmonary 
artery,  which  divides  into  two  branches,  that  for  the  right  lung  passing  behind  the  other 
great  vessels;  /,  /,  I,  I,  pulmonary  veins,  bringing  oxygenated  blood  to  m,  the  left  auricle; 
n,  the  left  ventricle,  from  which  the  blood  is  carried  to  the  organs  and  tissues  by  o,  the 
aorta;  p,  p,  q,  q,  carotid  and  subclavian  arteries,  given  off  from  the  arch  of  the  aorta. 

by  a  vertical  partition  into  two  lateral  halves  which  have  no  com- 
munication with  each  other.  Each  of  these  lateral  halves  is  further 
subdivided  by  a  horizontal  constriction  into  two  communicating 
cavities,  an  auricle  and  a  ventricle;  the  whole  heart  is  lined  by  a 
smooth  membrane,  the  endocardium,  and  all  its  openings  are  pro- 
tected by  valves  (Fig.  36). 

The  right  is  the  venous  side  of  the  heart ;  its  auricle  receives  the 
venous  blood  from  the  entire  body  through  the  superior  and  inferior 
vena  cava;  when  it  is  full  it  contracts  and  passes  the  blood  into  the 
right  ventricle,  which  in  its  turn  contracts  and  sends  the  blood  to 
the  lungs,  whence  it  is  returned  arterialized  to  the  left  auricle,  and 


74 


ANATOMY  AND  PHYSIOLOGY 


from  there  to  the  left  ventricle  which  forces  it  through  the  arteries  to 
all  parts  of  the  body.  This  contraction  or  beating  of  the  heart  takes 
place  about  seventy-two  times  to  the  minute.  The  valve  between 
the  auricle  and  ventricle  on  the  left  side  is  known  as  the  mitral,  that 
on  the  right  side  as  the  tricuspid,  while  the  valves  which  prevent 
regurgitation  from  the  aorta  and  pulmonary  arteries  are  known  as 
the  aortic  and  pulmonary,  respectively. 

The  arteries  are  elastic, 
muscular  tubes,  which  stand 
open  when  cut  across,  and 
are  without  valves  except  at 
their  exit  from  the  heart. 
The  elastic  tissue  in  their 
walls  allows  them  to  expand 
when  blood  is  forced  in  from 
the  heart,  and  by  subsequent 
contraction  to  maintain  a  uni- 
form pressure  between  heart- 
beats. It  is  this  expansion, 
caused  by  the  heart  forcing 
more  blood  into  the  already 
full  arteries,  which  consti- 
tutes the  pulse.  The  mus- 
cular tissue  allows  of  a  local 
regulation  of  the  circulation 
under  nervous  influences  such 
as  occur  in  blushing  or  the 
pallor  of  fear. 

The  arteries  freely  communicate  with  each  other  by  the  anastO' 
mosis  of  small  branches,  so  that  when  an  artery  becomes  blocked 
by  a  clot,  or  is  tied,  the  blood  goes  around  the  obstruction  by  means 
of  the  communication  between  the  small  branches  given  off  on  either 
side  and  the  collateral  circulation  is  established.  It  is  by  reason  of 
the  freedom  of  this  collateral  circulation  that  both  ends  of  a  cut 
artery  spurt,  and  but  for  it  gangrene  might  ensue  when  an  artery 
is  tied. 

By  the  constant  giving  off  of  branches  the  arteries  become  smaller 
and  smaller  until  they  finally  terminate  in  the  capillaries. 


The  Heart. 


lir,.  34. 

DIAGRAM  TO  SHOW  THE  COURSE  OF  THE  BLOOD  IN 
PASSING  FROM  A  GIVEN  POINT  THROUGH  THE  TWO 
SETS  OF  CAPILLARIES  TO  THE  STARTING  POINT. 


THE  BLOOD  AND  THE  CIRCULATORY  SYSTEM    75 

The  capillaries,  so  called  because  of  their  resemblance  to  minute 
hairs,  though  they  are  much  smaller  than  the  finest  hairs,  differ  from 
the  arteries  in  being  of  a  uniform  size  throughout,  and  in  having  only 
a  single  thin  celular  coat  through  which  the  ultimate  interchange  of 
materials  takes  place  between  the  blood  and  tissues. 

The  smallest  veins  start  from  the  capillaries  and  constantly  join 
each  other,  growing  larger  and  larger,  until  finally  all  the  venous 
blood  in  the  body  enters  the  right  side  of  the  heart  through  the 
superior  and  inferior  vena  cava.  The  pulmonary  veins,  unlike  other 
veins,  return  arterial  blood  from  the  lungs  to  the  left  auricle. 

Veins  differ  from  arteries  in  the  following  particulars :  Veins: 
The  contained  blood  is  dark  red ;  it  flows  in  a  continuous 
stream  without  spurting ;  it  flows  toward  the  heart.  The 
veins  have  thin  walls  so  that  they  collapse  when  cut 
across ;  bleeding  occurs  only  from  the  far  end  of  the  cut 
vein,  because  the  valves  (Fig.  37)  with  which  all  veins 
(except  those  of  the  rectum)  are  supplied  prevent  a 
backward  flow  of  blood  from  the  near  end.  Many  veins  Thl'°vi[vM 
are  superficial  and  may  be  seen  under  the  skin.  °^  *  ^'""• 

Arteries:  The  contained  blood  is  bright  red;  it  flows  in  waves, 
and  spurts  from  the  vessel  when  cut;  it  flows  away  from  the  heart. 
Arteries  have  thick  walls  and  stand  open  when  divided,  like  a  piece 
of  hose;  bleeding  occurs  from  both  ends,  owing  to  the  absence  of 
valves  and  the  freedom  of  the  collateral  circulation.  The  large 
arteries  are  deeply  placed  near  the  bone  and  are  usually  on  the  inner 
or  protected  side  of  a  limb.  The  circulation  of  the  blood  in  the 
arteries  is  effected  by  the  pumping  action  of  the  heart.  In  the  veins 
the  action  of  the  heart  is  only  one  factor,  the  other  two  being  pres- 
sure of  the  muscles  in  exercise  and  the  aspirating  power  of  the  chest 
in  inspiration.  When  the  muscles  contract  they  press  on  the  thin- 
walled  veins,  and,  as  the  blood  is  prevented  from  going  backward 
by  the  valves,  it  must  go  toward  the  heart.. 

When  any  obstruction  exists  in  the  course  of  a  vein  it  is  apt  to 
become  enlarged  or  varicose;  such  enlargements  we  see  in  the  leg, 
constituting  varicose  veins,  in  the  scrotum,  called  varicocele,  and 
about  the  anus,  called  hemorrhoids  or  piles. 

All  the  arterial  blood  leaves  the  left  ventricle  of  the  heart  by  means 
of  a  large  artery,  called  the  aorta  (Fig.  38)  ;  this  vessel  arches  back- 


76  ANATOMY  AND  PHYSIOLOGY 

ward  over  the  root  of  the  lung,  to  the  left  side  of  the  spinal  column, 
down  which  it  passes  to  the  fourth  lumbar  vertebra,  where  it  divides 
into  the  common  iliacs.  From  the  arch  of  the  aorta  are  given  off 
three  large  vessels,  the  innominate,  the  left  common  carotid,  and  the 
left  subclavian ;  the  innominate  soon  divides  into  the  right  common 
carotid  and  right  subclavian,  so  that  at  the  root  of  the  neck  the  two 
sets  of  arteries  are  symmetrical.  The  common  carotids  on  each  side 
pass  up  alongside  the  trachea,  or  windpipe,  where  they  can  be  felt, 
to  the  upper  border  of  the  thyroid  cartilage,  or  "Adam's  apple,", 
where  they  are  divided  into  the  internal  and  external  carotids.  The 
internal  carotids  supply  the  interior  of  the  cranium;  they  lie  just 
behind  the  tonsils  on  the  inside  of  the  throat.  The  external  carotids 
supply  the  exterior  of  the  cranium  and  face,  and  the  tongue;  the 
front  edge  of  the  sterno-mastoid  muscle  is  the  guide  to  this  artery; 
the  external  carotid,  or  better,  the  common  carotid,  may  be  com- 
pressed against  the  vertebral  column.  The  facial,  a  branch  of  the 
external  carotid,  curves  over  the  lower  jaw  about  an  inch  in  front  of 
its  angle  and  can  be  compressed  there ;  the  temporal,  another  branch, 
passes  up  just  in  front  of  the  ear  and  divides  into  an  anterior  and 
posterior  temporal  branch.  The  superior  and  inferior  coronary 
branches  of  the  facial  unite  with  those  from  the  opposite  side  to 
form  a  complete  arch  in  each  lip. 

The  subclavian  artery  passes  across  the  first  rib  just  behind  the 
clavicle,  then  beneath  the  clavicle  to  the  axilla,  where  its  name 
changes  to  axillary ;  in  the  hollow  behind  the  clavicle  the  subclavian 
can  be  felt  and  compressed  against  the  rib.  The  axillary  artery, 
where  it  passes  beyond  the  armpit,  is  called  bracial ;  the  brachial 
extends  from  the  lower  margin  of  the  axilla  down  the  inner  and 
anterior  aspect  of  the  arm,  and  terminates  about  a  half  inch  below 
and  in  front  of  the  bend  of  the  elbow,  where  it  divides  into  the  radial 
and  ulnar.  The  course  of  the  brachial  artery  is  roughly  indicated 
by  the  inner  seam  of  the  coat  sleeve,  or  by  a  line  drawn  from  the 
armpit  along  the  inner  border  of  the  biceps  muscle  to  the  front  of 
the  elbow ;  it  may  be  compressed  against  the  humerus. 

The  radial  artery  passes  down  the  radial  side  of  the  arm  to  the 
wrist,  where  it  winds  around  the  outer  side  and  then  passes  forward 
to  the  palm  between  the  thumb  and  index  finger ;  the  ulnar  artery  in 
like  manner  passes  down  the  ulnar  or  inner  side  of  the  arm  and 
divides    into   two   branches    which    anastomose   with    two    similar 


THE  BLOOD  AND  THE  CIRCULATORY  SYSTEM    77 

branches  from  the  radial,  forming  the  superficial  and  deep  palmer 
arches.  Both  the  radial  and  ulnar  are  deeply  buried  under  the 
muscles  until  just  above  the  wrist  where  they  become  superficial; 
it  is  at  this  point  that  the  beating  of  the  radial  is  felt  for  in  taking 
the  pulse.  The  position  of  the  palmar  arches  is  important,  because, 
owing  to  the  fact  that  they  receive  branches  from  both  the  radial 
and  ulnar  arteries,  bleeding  from  them  is  profuse  and  requires  for 
its  control  pressure  on  both  vessels.  The  superficial  palmar  arch 
is  on  a  line  with  the  lower  border  of  the  extended  thumb,  while  the 
deep  palmar  arch  is  a  half  inch  higher  up. 

The  digital  arteries,  which  supply  the  fingers,  are  branches  of  the 
palmar  arches  and  pass  along  both  sides  of  each  finger. 

In  the  thorax  the  aorta  gives  off  the  intercostals,  which  run  along 
the  inner  surface  of  the  upper  and  lower  borders  of  each  of  the  ribs ; 
in  the  abdomen  it  gives  off  important  branches  to  all  the  abdominal 
viscera,  and  divides  into  the  common  iliacs.  The  common  iliac  on 
each  side  passes  downward  and  outward  to  the  margin  of  the  pelvis 
where  it  divides  into  the  external  and  internal  iliac.  The  internal 
iliac  goes  to  the  interior  of  the  pelvis  and  supplies  it  together  with  its 
viscera  and  the  generative  organs.  The  external  iliac  passes  down- 
ward and  outward  to  the  fold  of  the  groin,  where  it  enters  the  thigh 
and  becomes  the  femoral.  The  femoral  artery  commences  at  the 
center  of  the  groin  and  passes  down  the  front  and  inside  of  the  thigh 
to  the  back  of  the  knee,  where  it  is  known  as  the  popliteal ;  its  course 
may  be  shown  by  stretching  a  string  from  the  center  of  the  groin  to 
the  back  of  the  knee;  just  below  the  groin  it  may  be  compressed 
against  the  head  of  the  femur. 

The  popliteal  artery  extends  from  the  termination  of  the  femoral 
to  just  below  the  knee  where  it  divides  into  the  anterior  and  posterior 
tibial ;  it  is  so  tightly  held  dov/n  under  fascia  and  tendons  that  it  is 
hardly  accessible  for  compression.  The  anterior  tibial  passes  for- 
ward between  the  tibia  and  fibula  to  the  front  of  the  leg  and  then 
down  deeply  beneath  the  muscles  to  the  front  of  the  ankle,  where  it 
becomes  the  dorsalis  pedis  which  is  distributed  to  the  back  of  the 
foot.  The  posterior  tibial  gives  off  a  large  branch,  the  peroneal,  and 
then  passes  down  the  back  of  the  leg  beneath  the  deep  muscles  to 
the  inner  ankle,  whence  it  passes  to  the  sole  of  the  foot  and  divides 
into  two  branches,  the  internal  and  external  plantar,  which  supply 
the  toes  with  digital  arteries  having  the  same  distribution  as  those  of 


78  ANATOMY  AND  PHYSIOLOGY 

the  lingers.  Behind  the  inner  ankle  the  posterior  tibial  may  be  felt 
and  compressed. 

The  veins  may  be  divided  into  three  sets,  the  pulmonary,  the 
systemic,  and  the  portal. 

The  pulmonary  veins  differ  from  all  others  in  that  they  convey 
arterial  blood  from  the  lungs  to  the  left  side  of  the  heart;  conversely, 
the  pulmonary  artery  conveys  venous  blood  from  the  right  ventricle 
of  the  lungs. 

The  systemic  veins  (Fig.  38)  are  arranged  in  two  sets,  deep  and 
superficial;  the  deep  veins  accompany  their  corresponding  arteries, 
each  of  the  large  arteries  of  the  leg,  forearm,  and  arm  having  two 
veins;  the  deep  veins  communicate  with  the  superficial  set.  The 
superficial  veins  lie  just  under  the  skin  where  they  can,  in  many 
localities,  be  plainly  seen;  those  of  the  lower  extremity  are  the 
internal  saphenous,  which  starts  on  the  top  and  inner  side  of  the  foot, 
runs  up  the  inside  of  the  leg  and  thigh  and  terminates  in  the  femoral 
just  below  the  groin,  and  the  external  saphenous  starting  in  like  man- 
ner on  the  outer  side  of  the  foot  and  emptying  into  the  popliteal 
behind  the  knee. 

Those  of  the  upper  extremity  are  the  radial  on  the  outer  side,  the 
ulnar  on  the  inner  side,  and  the  median  in  the  middle ;  opposite  the 
bend  of  the  elbow  the  median  splits  into  two  veins,  the  one,  known  as 
the  median  cephalic,  joining  with  the  radial  to  form  the  cephalic,  and 
the  other,  the  median  basilic,  uniting  with  the  ulnar  to  form  the 
basilic;  the  basilic  and  cephalic  both  empty  into  the  axillary.  The 
median  cephalic  is  the  vein  ordinarily  opened  in  bleeding.  The  great 
superficial  vein  of  the  neck  is  the  external  jugular,  which  passes 
down  from  the  angle  of  the  jaw  to  the  middle  of  the  clavicle ;  it  may 
be  brought  into  view  by  pressing  with  the  finger  just  above  the  mid- 
dle of  the  clavicle. 

The  portal  system  is  composed  of  four  large  veins  which  collect 
the  venous  blood  from  the  viscera  of  digestion.  The  trunk  formed 
by  their  union  (vera  porta)  enters  the  liver  and  breaks  up  into  cap- 
illaries from  which  another  set  of  veins,  the  hepatic  veins,  arise, 
which  terminate  in  the  vena  cava.  This  circulation  is  for  the  pur- 
pose of  subjecting  the  products  of  digestion  contained  in  these  veins 
to  the  special  action  of  the  liver  before  they  go  into  the  general 
circulation. 


Fig.   38.  —  The   Circulation,   Venous  and   Arterial. 


CHAPTER  VI 

THE  RESPIRATORY   APPARATUS 

The  respiratory  apparatus  consists  of  the  larynx,  trachea,  bronchi, 
and  lungs ;  the  thyroid  gland,  which  lies  upon  the  trachea,  may  be 
conveniently  considered  in  this  connection  (Fig.  39). 

The  larynx,  or  Adam's  apple,  is  the  organ  of  voice,  and  is  situated 
in  the  middle  line  of  the  neck,  where  it  may  be  felt  and  seen  mov- 
ing up  and  down  in  the  act  of  swallowing.  It  lies  between  the 
trachea  and  the  base  of  the  tongue,  and  its  upper  opening  is  closed 
during  swallowing  by  a  cartilaginous  flap  called  the  epiglottis;  when 
the  tongue  is  drawn  well  forward,  especially  if  the  patient  gags,  the 
epiglottis  may  be  seen  as  a  white  cartilage  curving  forward  over 
the  root  of  the  tongue.  When  one  chokes  in  swallowing  because 
the  food  is  said  to  have  "  gone  the  v/rong  way,"  it  means  that  the 
epiglottis  has  failed  to  close  efficiently  the  opening  into  the  larynx, 
and  food  has  gotten  in,  causing  coughing  for  its  expulsion. 

The  larynx  is  composed  externally  of  cartilage;  internally  two 
white  fibrous  bands  stretch  from  front  to  rear,  and  are  known  as  the 
vocal  cords;  it  is  the  vibration  of  these  vocal  cords  that  produces 
sound. 

The  trachea  or  windpipe  is  a  cartilaginous  and  membranous  tube 
which  extends  downward  'about  four  and  one-half  inches  from  the 
larynx  to  its  division  into  the  two  bronchi,  one  of  which  goes  to 
each  lung.  The  cartilages  of  the  trachea  and  bronchi  are  arranged 
in  rings,  and  serve  the  purpose  of  keeping  the  windpipe  open.  The 
right  bronchus  is  larger  and  shorter  than  the  left,  and  foreign  bodies 
which  get  into  the  windpipe  usually  lodge  in  this  bronchus. 

The  bronchi  divide  and  subdivide  and  give  off  branches  like  a 
tree,  at  the  same  time  gradually  losing  their  cartilages  and  getting 
thinner  and  thinner  until  the  little  bronchioli  terminate  in  a  sack  the 
walls  of  which  are  studded  with  air  cells,  a  terminal  bronchus  and 
its  air  cells  resembling  a  bunch  of  grapes. 

The  termination  of  the  bronchi  together  with  the  air  cells  con- 
stitutes the  lung  tissue  proper. 

When  the  larynx  becomes  obstructed  bv  disease  so  that  air  cannot 
6  (81) 


82 


ANATOMY  AND  PHYSIOLOGY 


get  into  the  lungs  and  death  is  otherwise  imminent,  a  tube  is  intro- 
duced into  the  larynx  between  the  vocal  cords,  intubation,  or  an  open- 
ing is  made  into  the  trachea  and  a  tube  inserted  there,  tracheotomy. 

The  lungs  are  the  essential  organs  of  respiration;  they  are  com- 
monly known  as  ''  lights,"  and  with  the  heart  between  them  fill  the 
entire  chest  cavity  (Fig.  35).  Each  is  covered  by  a  smooth,  shining 
serous  membrane  which 
also  lines  the  chest 
cavity  and  is  called  the 
pleura.  Ordinarily  the 
lungs  are  everywhere  in 
contact  with  the  chest 
walls,  but  when  an  open- 
ing is  made  in  the  chest, 
as  by  a  shot  or  stab 
wound,  or  when  inflam- 
mation of  the  pleura 
occurs  and  fluid  is 
poured  out,  a  space  is 
formed  between  the 
lung  and  the  chest  wall, 
known  as  the  pleural 
cavity  (Fig.  40). 

The    right    lung    has 
three  lobes,  the  left  lung 

tuTrt      nr\A     oar-U     ic     t-r\m  Fi°-  39- — The  Larynx,  Trachea,  Right  and  Left  Bron- 

IWO,  dim  eacn  lt>  com-  ^^^^^  ^^^  ^^le  Lungs.  The  latter  have  been  cut  open  to 
Onsed      of      bronchi        air    ^'^°'^    ^^^    method    of    division    and    subdivision    of    the 

cells,    and   the   divisions 

and  subdivisions  of  the  pulmonary  arteries  and  veins. 

In  the  ultimate  air  cells  the  venous  blood  of  the  pulmonary  arteries 
circulating  in  the  capillaries  is  brought  in  contact  with  the  air  in  the 
cells,  and  the  interchange  takes  place  which  results  in  the  blood 
receiving  a  supply  of  oxygen  and  becoming  arterial,  while  the  air 
becomes  charged  with  carbonic  oxide,  waste  organic  matter,  and 
watery  vapor. 

In  inflammation  of  the  lungs,  pneumonia,  these  air  cells  become 
filled  with  liquor  sanguinis  containing  some  red  blood  cells,  so  that 
air  can  no  longer  enter  and  that  portion  of  the  lung  is  temporarily 
useless.     In  laryngitis  and  bronchitis  mucus  is  poured  out  into  the 


THE  RESPIRATORY  APPARATUS 


83 


bronchi  and  coughed  up,  but  the  air  cells  are  free;  hence  those 

affections  are  much  less  serious. 

Breathing  or  respiration  consists  in  the  alternate  expansion  and 

contraction  of  the  chest,  by  which  air  is  drawn  in  and  forced  out; 

the  drawing  in  is  known  as  inspiration  and  the  forcing  out  as  expira- 
tion.    The  number  of  these  movements  m  health  is  about  eighteen 

to  the  minute.  In  ordi- 
nary quiet  respiration 
the  principal  muscle 
concerned  is  the  dia- 
phragm, which  in  its  re- 
laxed state  is  arched  up- 
ward into  the  cavity  of 
the  chest";  in  its  con- 
traction the  muscle  is 
flattened  out,  largely  in- 
creasing the  capacity  of 
the  chest,  so  that  the  air 
rushes  in  through  the 
larynx  to  fill  the  vacu- 
um; inspiration  com- 
])leted,  the  diaphragm 
relaxes,  the  chest  walls 
collapse,  and  expiration 
(Kcurs.  When  respira- 
tion becomes  more  ac- 
tive the  intercostal 
muscles,  which  raise  the 
ribs,  come  into  play, 
and  when  still  more 
effort  is  required  all  the 
muscles  attached  to  the 

chest  come  into  action,  and  even  the  nostrils  are  dilated  to  allow  the 

entrance  of  more  air. 

Ordinary  outdoor  air  contains  about  twenty-one  parts  of  oxygen, 

seventy-nine  parts  of  nitrogen,  and  four  hundredth  parts  of  car1x)nic 

acid,  or  four  parts  in  ten  thousand. 

The  oxygen  is  the  element  of  the  air  which  is  necessary  to  sustain 

life;  it  serves  the  same  purpose  as  it  does  in  a  fire;  maintains  the 


Fig.  40. —  Chest  showing  Pleurae. 


84  ANATOMY  AND  PHYSIOLOGY 

combustion  by  which  heat  and  force  are  produced.  If  you  shut  off 
tlie  supply  of  air  (oxygen)  to  a  furnace  the  fire  goes  out ;  if  you  shut 
off  the  supply  to  the  lungs  life  goes  out.  The  nitrogen  has  no  other 
value  than  to  dilute  the  oxygen. 

When  air  is  breathed  it  loses  a  portion  of  its  oxygen,  is  raised  in 
temperature,  and  has  added  to  it  in  the  lungs  carbonic  acid,  organic 
matter,  and  the  vapor  of  water;  the  amount  of  contained  carbonic 
acid  is  increased  a  hundred  times,  to  about  four  per  cent. 

As  the  air  in  a  confined  space  is  breathed  over  and  over  again, 
headache  and  drowsiness  are  etscperienced,  and  even  death  may  result. 

A  notable  instance  of  this  character  occurred  in  India  in  the  year 
1756,  when  one  hundred  and  fifty-six  British  prisoners  were  confined 
in  a  dungeon  eighteen  feet  square;  the  next  morning  one  hundred 
and  twenty-three  of  them  were  dead. 

The  causes  of  these  results  were  formerly  supposed  to  be  de- 
ficiency of  oxygen,  increase  of  carbonic  acid,  and  organic  matter. 
Now  we  believe  that  the  real  causes  are  increased  temperature  and 
humidity,  and  stagnation  of  the  confined  air;  just  how  these  factors 
act,  we  do  not  know,  but  experience  has  demonstrated  that  when 
the  air  is  kept  in  motion,  and  the  temperature  reduced,  the  unpleasant 
symptoms  do  not  occur. 

The  inflow  of  fresh  air  to  take  the  place  of  that  which  has  been 
breathed  is  known  as  ventilation. 

The  heat  which  is  produced  in  the  body  by  the  burning  or  oxida- 
tion of  carbon,  the  resulting  carbonic  acid  escaping  through  the 
lungs,  would  raise  the  temperature  of  the  body  too  high  were  it  not 
that  provision  is  made  for  its  regulation.  The  evaporation  of  water 
is  the  principal  cooling  agency,  the  evaporation  taking  place  from 
the  lungs  and  skin ;  this  is  going  on  all  the  time,  though  the  vapor 
from  the  lungs  is  only  visible  in  cold  weather.  So  with  the  skin, 
the  water  is  only  visible  in  hot  weather,  when  so  much  escapes  that 
the  unevaporated  portion  becomes  visible  as  szveat  or  perspiration; 
the  harder  we  work,  the  more  heat  is  produced,  and  the  more 
evaporation  of  water  is  required  to  reduce  the  body  temperature. 
If  the  skin  stops  action  the  body  temperature  rapidly  rises,  and  we 
have  the  condition  of  heat  stroke,  in  which  the  hot,  dry  skin  is  a 
familiar  symptom. 


CHAPTER   VII 

THE   EXCRETORY   APPARATUS 

We  have  already  seen  that  in  all  life  processes  waste  products  and 
poisons  are  produced,  which,  if  not  gotten  rid  of,  are  finally  fatal 
even  to  the  life  which  produced  them.  The  yeast  fungus  growing  in 
sugar  solution  produces  a  poison,  alcohol,  which  when  it  reaches  a 
certain  proportion  destroys  the  life  of  the  yeast;  so  with  the  human 
body,  it  produces  very  deadly  poisons  which  must  be  thrown  off  if 
the  body  would  live,  and  the  apparatus  by  which  these  poisons  are 
eliminated  is  known  as  the  excretory  apparatus.  The- skin,  lungs, 
large  intestine,  and  urinary  apparatus  all  take  part  in  excretion. 

The  excretory  functions  of  the  skin,  lungs,  and  rectum  have  been 
fully  described  elsewhere.  It  remains  to  give  a  description  of  the 
urinary  apparatus,  whose  practically  sole  function  is  excretion.  It 
consists  of  the  kidneys  which  secrete  the  urine  and  the  ureters  which 
convey  it  to  the  bladder,  where  it  accumulates  until  it  is  convenient 
to  discharge  it  through  the  urethra. 

The  kidneys  (Fig.  32),  one  on  each  side,  are  situated  in  the  loins, 
at  the  back  of  the  abdomen,  behind  the  peritoneum,  on  either  side 
of  the  spinal  column,  and  just  below  the  last  rib.  They  are  about 
four  inches  long  by  two  and  a  half  inches  wide,  by  one  and  an  eighth 
inches  thick,  and  weigh  about  five  ounces  each.  They  are  covered 
by  a  fibrous  capsule  which  may  be  stripped  off,  and  consist  of  two 
portions,  a  cortex  and  a  medullary  portion.  The  cortex  is  the 
secreting  part,  while  the  medulla  is  largely  an  aggregation  of  urinary 
tubules  on  their  way  to  the  pelvis  of  the  kidney. 

Each  urinary  tubule,  after  many  twists  and  loops,  terminates  in  a 
little  sack,  in  which  is  a  bunch  or  tuft  of  tortuous  capillaries;  the 
veins  emerging  from  these  capillaries  are  smaller  than  the  arteries 
that  empty  into  them,  so  that  the  blood  in  passing  through  is  sub- 
jected to  some  degree  of  pressure,  and  under  the  pressure  water 
and  salts  escape  from  the  vessels.  Farther  on  down  the  tubule  the 
secreting  epithelium  with  which  the  tubule  is  lined  takes  from  the 

(85) 


86 


ANATOMY  AND  PHYSIOLOGY 


blood  the  urea  and  other  waste  products  necessary  to  purify  it  and 
complete  the  urine. 

On  the  inner  side  of  each  kidney  is  a  deep  depression  containing 
a  funnel-shaped  sac,  the  pelvis,  which  receives  the  terminations  of 
the  urinary  tubules,  and  is  itself  the  starting  point  of  the  ureters. 
The  ureters  are  two  musculo-membranous  tubes,  about  the  size  of 
a  goose  quill,  and  sixteen  inches  long,  extending  from  the  pelvis  of 
the  kidneys  to  the  urinary  bladder  (Fig.  41). 

When  a  stone  formed  in  the  pelvis  of  the  kidney  finds  its  way 
into  one  of  these  ureters,  in  its  passage  to  the  bladder,  it  naturally 
has  a  hard  time  in  getting 
through  such  a  small  canal, 
and  the  result  is  the  excruciat- 
ing pain  experienced  in  such 
a  condition  which  is  known 
as  renal  colic. 

The  bladder  is  a  muscular 
bag  which  serves  as  a  reser- 
voir for  the  urine  and  in  a 
moderately  distended  condi- 
tion holds  about  a  pint.  When 
empty  or  containing  only  a 
small  amount  of  urine  it  lies 
wholly  within  the  pelvis,  and 
behind  the  pubis ;  when  full 
it  rises  into  the  abdomen  and 
can  be  felt  and  percussed 
above  the  pubis.  To  deter- 
mine whether  the  bladder  is 
full    we    tap   on    the    finger 

placed  just  above  the  pubis ;  if  we  get  a  hollow  sound  we  know  that 
it  cannot  be  distended  (Fig.  42). 

As  the  bladder  rises  into  the  abdomen  it  leaves  exposed  in  front 
a  small  area  not  covered  by  the  peritoneum  and  through  which  it  can 
be  aspirated  without  opening  the  peritoneum.  Likewise  there  is  a 
similar  area  behind,  where  the  bladder  rests  on  the  rectum  and 
through  which  it  can  be  reached.  The  neck  of  the  bladder  is  em- 
braced by  the  prostate  gland  which  in  old  men  becomes  enlarged 
and  makes  a  bar  to  the  passage  of  urine. 


Fig. 


41. — 'Section   of  the  Kidney.     A,  Cortex; 
B,  medulla;  C,  pelvis;  D,  ureter. 


THE  EXCRETORY  APPARATUS 


87 


The  urethra  is  eight  or  nine  inches  long  and  extends  from  the 
neck  of  the  bladder  to  the  meatus:  when  the  penis  is  held  up  that 
portion  of  the  urethra  under  the  pubis  describes  a  curve  with  the 
concavity  upward,  hence  the  curved  shape  of  catheters  and  sounds. 

Urine  is  a  watery  solution  of  urea,  uric  acid,  coloring  matter,  and 
salts,  mostly  urates,  phosphates,   carbonates,   and  chlorides.     The 


MuJC.  iricutt 


emintt 


^restate  q/anc^ 
C<fW/ierso/an<l 


CoiytitJ  J^nffia^um. 


GLa.HJ' 

Fig.  42. —  Section  of  Bladder  and  Urethra. 

average  man  passes  about  fifteen  hundred  cubic  centimeters  or  three 
pints  of  urine  a  day,  and  this  urine  contains  about  fifty  grammes  or 
one  and  one-half  ounces  of  .solids.  Normal  urine  is  yellowish  in 
color,  acid  in  reaction,  and  has  a  specific  gravity  of  from  1015  to 
1025. 

The  urea  is  the  most  important  constituent,  a  little  more  than 
an  ounce  being  excreted  daily. 

Healthy  urine  when  passed  is  ordinarily  clear,  but  it  may  quickly 
become  cloudy  and  a  sediment  form  without  indicating  disease.  If 
such  cloudiness  disappears  when  the  urine  is  heated  it  is  due  to 


88  ANATOMY  AND  PHYSIOLOGY 

urates;  if  the  cloudiness  disappears  on  the  addition  of  a  few  drops 
of  acid  it  is  due  to  phosphates. 

Among  abnormal  constituents  of  the  urine,  indicating  disease,  are 
albumin,  sugar,  bile,  blood,  and  pus. 

Just  above  the  kidney  on  each  side  is  a  small  triangular  ductless 
gland  known  as  the  suprarenal  gland.  It  has  nothing  to  do  with  the 
excretion  of  urine  but  is  considered  here  for  convenience.  That 
these  little  glands  add  something  important  to  the  blood  is  shown 
by  the  fact  that  their  removal  in  animals  is  quickly  followed  by 
death,  and  that  their  diseased  condition  in  man  is  the  cause  of  a 
fatal  malady  known  as  Addison's  disease.  Their  function  appears 
to  be  to  sustr.in  muscular  tone,  especially  in  the  blood-vessels,  and  a 
substance  known  as  adrenalin  has  been  isolated  from  them  which 
has  a  very  powerful  effect  in  that  direction. 


PART  III 

FIRST    AID 

CHAPTER   I 

EMERGENCIES,   CONTUSIONS,   AND   WOUNDS 

One  of  the  most  important  of  the  many  duties  of  the  hospital- 
corps  man  is  to  render  first  aid ;  in  time  of  war  it  becomes  his  most 
important  duty.  In  order  that  this  duty  shall  be  performed  promptly 
and  efficiently  and  without  excitement  or  hesitation  he  must  be  taught 
what  to  do  until  he  possesses  the  confidence  born  of  knowledge. 

If  called  upon  for  assistance  in  an  emergency  under  other  con- 
ditions than  those  of  an  action  his  first  duty  is  to  send  word  to  a 
medical  officer;  in  action  this  often  can  not  be  done.  The  next  step 
is  to  see  that  the  sick  or  injured  man  is  not  crowded  about  so  that 
he  can  not  get  air;  then  the  nature  of  the  case  must  be  ascertained  as 
quickly  as  possible.  Look  for  bleeding;  if  it  is  at  all  profuse  it 
must  be  stopped  at  once;  if  there  is  shock  lower  the  head  and  give 
a  little  aromatic  spirits  of  ammonia  in  water;  if  there  is  a  wound 
protect  it  by  a  first-aid  dressing,  ripping  up  the  clothing  if  necessary 
to  get  at  it,  but  not  attempting  to  clean  or  handle  it  in  any  way;  if 
there  is  a  fracture  immobilize  it  before  moving  the  patient  a  foot,  so 
that  a  simple  fracture  may  not  be  made  compound.  Then  remove 
any  equipments  the  soldier  may  have  on,  unbutton  his  collar,  and 
loosen  the  clothing  about  his  chest  and  abdomen. 

In  action  the  amount  of  first  aid  to  be  rendered  will  depend  on 
circumstances;  perhaps  the  arrest  of  severe  hemorrhage  is  all  that 
can  be  attempted. 

The  clothing  must  be  preserved  as  far  as  possible,  for  it  is  often 
impossible  to  replace  it.  On  reaching  the  hospital  the  clothing  must 
be  very  gently  removed.     To  remove  a  shirt,  pull  it  up  from  the  back, 

(89) 


90  FIRST  AID 

then  draw  it  over  the  head  to  the  front,  and  lastly  disengage  the 
arms ;  if  one  arm  is  injured  disengage  the  well  arm  first,  then  draw 
the  shirt  over  the  head,  and  lastly  free  the  injured  arm;  if  necessary 
rip  up  the  seam  on  the  injured  side. 

A  contusion  or  bruise  is  a  subcutaneous  or  closed  wound :  a  lacer- 
ation of  the  deeper  tissues  without  a  division  of  the  skin.  Contusions 
vary  in  extent  from  an  ordinary  "  black  and  blue  "  spot,  to  the  almost 
complete  pulpification  of  a  limb  with  laceration  of  the  blood-vessels 
and  nerves  such  as  sometimes  occurs  in  railway  or  other  accidents. 
The  first  evidence  of  contusion  is  usually  rapid  swelling  of  the  part; 
every  one  knows  that  when  one  is  struck  a  hard  blow  on  the  e\'e  the 
swelling  closes  it  almost  immediately,  or  a  blow  on  the  head  is 
promptly  followed  by  a  "  bump."  There  is  only  one  thing  which 
could  cause  such  rapid  swelling,  and  that  is  bleeding  caused  by  the 
laceration  of  the  subcutaneous  tissues  and  vessels,  the  blood  not 
being  able  to  escape.  At  first  there  is  no  discoloration,  but  after  a 
few  hours  or  a  day,  the  blood  makes  its  way  toward  the  surface, 
and  the  part  looks  black  and  blue  and,  as  changes  later  take  place  in 
the  blood,  greenish  or  yellow.  Another  symptom  is  pain.  If  the 
injury  is  severe  there  is  shock ;  the  more  shock  the  less  pain  usually. 
Shock  is  a  condition  of  nervous  depression  like  fainting,  only  shock 
is  due  to  physical  causes,  while  fainting  is  due  to  mental  impressions. 
The  symptoms  of  shock  are  anxiety,  pallor,  dilated  pupils,  trembling, 
chilly  feeling,  nausea,  clammy  skin,  very  weak  pulse,  sighing  respira- 
tion, often  a  subnormal  temperature.  The  amount  of  shock  will 
depend  upon  the  part  of  the  body  injured  and  the  gravity  of  the  in- 
jury; it  is  much  more  marked  in  injuries  of  the  trunk  than  In  in- 
juries of  the  extremities ;  injuries  of  the  testicle  are  apt  to  be  attended 
with  marked  shock.  Shock  may  be  so  severe  as  to  terminate  fatally 
without  reaction. 

The  treatment  of  shock  consists  in  the  use  of  heat  externally  and 
stimulants  internally,  hemorrhage  must  be  carefully  looked  for  and 
controlled  if  present.  In  severe  shock  on  the  field  it  is  often  safer 
not  to  attempt  to  move  the  patient  until  there  are  signs  of  reaction ; 
give  him  some  stimulant  and  leave  him  temporarily.  If  he  can  be 
moved  get  him  in  bed  as  quickly  as  possible ;  wrap  him  in  hot  blankets 
and  surround  him  with  bottles  of  hot  water;  give  him  hot  coffee  or 
hot  beef  tea ;  keep  him  perfectly  quiet  with  the  head  low. 

For  the  treatment  of  the  contusion  itself  the  indication  is  to  stop 


EMERGENCIES,  CONTUSIONS  AND  WOUNDS       91 

the  subcutaneous  bleeding ;  this  can  be  done  by  very  hot  or  very  cold 
applications ;  if  the  injury  is  in  a  limb,  firm,  even  pressure  of  a  band- 
age may  be  effective.  Later  when  the  bleeding  has  ceased  the  ab- 
sorption of  the  extravasated  blood  may  be  hastened  by  hot  fomen- 
tations and  massage. 

A  wound  is  a  division  not  only  of  the  tissues  but  of  the  overlying 
skin.  Wounds  are  classed  as  incised,  lacerated,  contused,  punctured, 
and  poisoned;  gunshot  wounds  are  usually  considered  in  a  class  by 
themselves. 

An  incised  wound  is  one  made  with  a  sharp  cutting  instrument, 
the  class  of  wounds  commonly  known  as  cuts,  such  as  cuts  with  a 
razor  or  knife. 

A  lacerated  zvound  is  a  torn  wound,  such  as  is  made  by  barbed 
wire  or  a  piece  of  shell ;  it  does  not  differ  practically  from  a  contused 
or  bruised  wound  made  with  a  blunt  instrument  such  as  a  club  or 
stick. 

A  punctured  wound  is  deep  and  narrow;  stabs  are  punctured 
wounds. 

A  poisoned  wound  is  one  in  which  some  poison  has  been  intro- 
duced by  the  same  agent  which  made  the  wound ;  any  of  the  above- 
named  classes  of  wounds  may  be  poisoned. 

Gunshot  wounds  are  both  punctured  and  contused;  they  may  also 
be  lacerated. 

Incised  wounds  are  especially  apt  to  be  attended  by  bleeding; 
lacerated  and  contused  wounds  are  less  apt  to  give  rise  to  dangerous 
hemorrhage  because  the  vessels  are  torn  and  twisted;  a  limb  may 
even  be  entirely  torn  off  without  serious  bleeding,  but  shock  in  this 
class  of  wounds  is  apt  to  be  severe. 

Punctured  wounds  are  dangerous  because,  while  the  external 
opening  may  be  small,  they  often  penetrate  so  deeply  as  to  seriously 
injure  important  organs,  or  cause  internal  hemorrhage. 

The  immediate  dangers  of  wounds  are  hemorrhage  and  shock;  if 
these  are  removed  the  one  great  danger  is  infection;  if  that  can  be 
prevented  the  most  serious  wounds  may  be  recovered  from  unless  of 
course  there  is  irreparable  injury  to  some  important  organ. 

The  healing  of  wounds  takes  place  in  two  ways;  if  there  is  no  in- 
fection and  no  loss  of  tissue  and  the  parts  are  brought  into  proper 
apposition  healing  occurs  by  first  intention;  otherwise  by  granulation 
with  or  without  suppuration. 


92  FIRST  AID 

Most  incised  and  small-arm  bullet  wounds  are  originally  aseptic, 
or  germ  free,  and  if  kept  so  will  heal  or  grow  together  under  one 
dressing,  without  heat,  redness,  severe  pain  or  swelling,  and  without 
fever.  The  bullet  itself  after  it  has  lodged  is  usually  harmless  and 
may  be  ignored  as  far  as  the  treatment  is  concerned. 

If  the  wound  becomes  infected  with  pus  cocci,  inflammation  occurs 
with  its  attendant  symptoms  of  heat,  redness,  pain  and  swelling,  and 
usually  more  or  less  fever ;  suppuration  follows,  and  if  the  pus  can- 
not escape  freely  some  of  the  pofsons  produced  by  the  growth  of  the 
pus  cocci  are  absorbed,  septic  toxemia,  or  the  cocci  themselves  get 
into  the  blood-vessels,  septic  infection;  the  septic  infection  may 
result  in  the  formation  of  abscesses  in  the  different  parts  of  the  body, 
pyemia.  All  these  blood  poisonings  are  attended  by  chills,  or  chilly 
feelings,  fever,  headache,  a  peculiar  waxy  appearance  of  the  skin, 
and  perhaps  delirium  and  stupor.  Unless  arrested  the  process 
terminates  in  death. 

Recent  war  experience,  with  its  constant  trench  fighting,  has 
shown  that  under  the  new  conditions  many  wounds,  especially  those 
caused  by  shrapnel,  shell,  and  hand  grenades,  are  primarily  infected, 
and  not  only  with  the  bacteria  of  suppuration  but  often  with  those 
of  gas-gangrene  and  tetanus.  If  infected  with  the  germs  of  gas- 
gangrene,  the  wound  quickly  becomes  foul  and  sloughy,  and  full  of 
gas,  so  that  it  crackles  under  pressure. 

The  first-aid. treatment  of  wounds  consists  in  the  arrest  of  hem- 
orrhage—  and  by  hemorrhage  must  be  understood  serious  bleeding, 
and  not  the  moderate  bleeding  which  accompanies  most  wounds  and 
only  requires  the  pressure  of  a  dressing — the  relief  of  shock  and 
the  prevention  of  infection. 

To  prevent  infection  is  all-important  and  may  be  accomplished 
by  following  a  few  simple  rules :  do  not  touch  the  wound  with  the 
fingers  or  anything  else;  do  not  attempt  to  wash  it  or  remove 
particles  of  dirt  or  clothing;  if  the  intestine  is  protruding  do  not 
attempt  to  replace  it ;  if  the  sharp  end  of  a  broken  bone  is  sticking 
through  leave  it  undisturbed ;  remove  the  soiled  and  bloody  clothing  ■ 
about  the  wound,  paint  the  wound  and  surrounding  skin  with  tincture 
of  iodine,  allow  it  to  dry,  and  apply  the  contents  of  the  first-aid 
packet,  handling  the  gauze  with  the  waxed  paper  so  as  if  possible 
not  to  touch  any  part  of  the  dressing  with  the  fingers. 

Each  soldier  in  the  field  is  issued  a  first-aid  packet  for  his  in- 


EMERGENCIES,  CONTUSIONS  AND  WOUNDS       93 

dividual  use;  it  has  a  hermetically  sealed  metal  cover,  and  contains 
two  compresses  of  absorbent  sublimated  gauze,  each  sewed  to  the 
center  of  a  sublimated-gauze  bandage,  each  bandage  being  wrapped 
in  parchment  or  waxed  paper  and  two  safety  pins  wrapped  in  waxed 
paper. 

The  first-aid  packet  is  carried  by  all  officers  and  enlisted  men. 

To  protect  the  extensive  wounds  often  caused  by  shell  fire  the 
ordinary  first-aid  packet  is  not  large  enough,  so  that  these  packets 
are  now  supplied  in  two  sizes. 

The  larger  or  "  shell-wound  dressing  "  is  wrapped  in  tough  paper 
with  directions  for  application  printed  thereon,  and  each  contains 
I  square  yard  of  absorbent  sublimated  (i:i,ooo)  gauze  so  folded 
as  to  make  a  pad  six  by  nine  inches,  stitched  to  the  back  of  each  end 
of  this  compress  is  a  piece  of  gauze  bandage  three  inches  wide  by 
forty-eight  inches  long.  The  dressing  also  contains  one  absorbdn.t 
sublimated-gauze  bandage  three  inches  wide  by  five  yards  long,  and 
two  safety  pins. 

If  a  first-aid  packet  is  not  at  hand,  the  dressing  may  be  of  ordi- 
nary sterilized  gauze,  or  any  other  thoroughly  clean  material,  dry  if 
possible. 

Wounds  of  the  skull  if  penetrating  are  usually  accompanied  by 
injury  to  the  brain  which  will  be  manifested  by  unconsciousness, 
paralysis,  unequal  pupils,  etc.  No  special  first-aid  treatment  is  re- 
quired. 

Woxmds  of  the  chest  if  penetrating  are  usually  attended  by  inju'ry 
to  the  lungs.  The  signs  of  penetration  of  the  chest  cavity  are  the 
presence  of  air  bubbles  in  the  wound,  difficult  breathing,  cough,  and 
spitting  of  blood.  The  treatment  consists  in  laying  the  patient  on 
the  injured  side  and  firmly  bandaging  the  chest. 

Wounds  of  the  abdomen  may  or  may  not  be  penetrating,  and  there 
may  or  may  not  be  injury  to  the  viscera.  The  signs  of  injury  of  the 
intestine  are  the  escape  of  gas  or  feces  through  the  wound  and  the 
passage  of  blood  in  the  stools. 

Injury  to  the  stomach  may  be  attended  with  the  escape  of  its  con- 
tents and  by  vomiting  of  blood.  No  special  first-aid  treatment  is 
required  in  these  conditions,  except  that  the  patient  should  be  placed 
in  such  a  position  as  may  favor  the  escape  externally  of  the  contents 
of  the  intestinal  tract. 

Injury  of  the  bladder  is  shown  by  the  escape  of  urine  through  the 


94  FIRST  AID 

wound  and  the  passage  of  blood  in  the  urine;  if  these  signs  are 
present  the  urine  should  be  drawn  frequently  to  prevent  its  escape 
into  the  abdomen. 

In  all  cases  of  injury  to  the  abdominal  viscera  the  signs  of  shock 
are  usually  well  marked. 

Poisoned  zvounds  may  be  divided  into  those  in  which  the  poison 
is  chemical,  including  the  bites  and  stings  of  insects,  scorpions,  ta- 
rantulas, centipedes,  and  snakes;  and  those  in  which  it  is  bacterial, 
including  the  bites  of  man  and  other  animals,  not  rabid,  the  bites  of 
rabid  animals,  and  wounds  infected  with  tetanus  or  anthrax. 

The  bites  and  stings  of  insects  cause  considerable  smarting  and  if 
in  loose  tissues  often  much  swelling;  relief  may  be  afforded  by  the 
application  of  ammonia,  soda,  or  even  wood-ashes ;  the  sting  if  left  in 
the  wound  should  be  extracted.  The  bites  of  the  tarantula  and  centi- 
pede and  the  sting  of  the  scorpion  may  cause  great  pain,  considerable 
shock,  and  much  local  swelling  and  inflammation,  but  are  seldom  or 
never  fatal.  The  treatment  is  the  same  as  for  the  bites  of  other  in- 
sects, but  in  very  severe  cases  it  may  be  necessary  to  incise  the 
wound  and  suck  out  the  poison.  Stimulants  may  be  given  if  neces- 
sary and  morphine  for  the  pain. 

When  a  person  is  bitten  by  a  poisonous  snake,  of  which  the  rattle- 
snake and  copperhead  are  the  principal  varieties  in  this  country, 
prompt  action  is  required. 

If  the  wound  is  in  the  extremity  tie  a  bandage  or  handkerchief 
tightly  about  the  limb  above  the  wound ;  incise  the  wound  freely  and 
suck  out  as  much  of  the  poison  as  possible ;  then  with  a  hypodermic 
syringe  inject  a  two-per-cent  solution  of  permanganate  of  potash  into 
and  about  the  bite  so  as  to  destroy  any  poison  which  is  left.  If  a  hy- 
podermic syringe  and  permanganate  solution  are  not  available,  the 
bite  should  be  cauterized  with  a  lighted  match,  a  hot  coal,  or  a  lit- 
tle gunpowder  rubbed  in  and  ignited.  Meanwhile  give  stimulants 
freely  but  not  to  the  point  of  intoxication.  The  ligature  should  be 
loosened  about  every  half-hour  so  as  to  allow  restoration  of  the  cir- 
culation, but  should  be  immediately  tightened  up  if  symptoms  of 
general  poisoning  occur. 

The  bites  of  man  and  other  animals  not  rabid  are  always  more  or 
less  poisonous  from  the  presence  of  the  bacteria  constantly  found  in 
the  mouth  and  on  the  teeth ;  sometimes  they  are  fatal ;  such  wounds 
should  be  thoroughly  disinfected  and  wet  antiseptic  dressings  applied. 


EMERGENCIES,  CONTUSIONS  AND  WOUNDS       95 

Rabies  or  hydrophobia  is  a  very  fatal  disease  caused  by  the  bite  of 
a  rabid  animal  or  "  mad  dog."  The  effect  is  not  immediate  like  that 
of  snake  bite,  but  may  be  delayed  weeks  or  months. 

The  treatment  of  the  bite  when  the  animal  is  known  to  be  rabid 
is  exactly  like  that  of  snake  bite,  but  no  ligature  need  be  used. 

Tetanus  or  lock-jaza  is  a  disease  the  result  of  a  wound  infected  by 
the  bacillus  of  tetanus.  It  is  especially  apt  to  occur  after  toy-pistol 
wounds  or  any  wound  in  which  dirt  has  been  carried  deeply  into  the 
tissues.  It  has  been  very  common  in  wars  where  the  fighting  occurs 
in  trenches  made  in  cultivated  fields  which  have  been  enriched  with 
stable  manure. 

The  tetanus  germ  grows  best  in  the  absence  of  air;  hence  it 
thrives  in  deep,  punctured  wounds.  The  germs  are  found  in  the  soil 
especially  about  gardens,  stables,  and  in  the  streets.  Wounds  of 
such  a  character  should  be  opened  up  freely,  disinfected,  and  drained. 
If  available,  tetanus  antitoxin  should  be  injected  into  and  about 
the  wound. 

Anthrax  or  malignant  pustule  is  sometimes  caused  by  the  bite  of 
an  infected  fly.  It  starts  as  a  very  hard  swelling  like  a  carbuncle, 
often  on  the  lip.  If  its  nature  is  recognized  it  should  be  at  once  ex- 
cised. 

In  warfare  with  savage  peoples  the  latter  often  used  poisoned 
weapons,  especially  arrows.  Many  different  poisons  are  used,  vege- 
table, animal,  and  bacterial. 

The  local  treatment  is  the  same  as  that  of  snake  bite ;  the  general 
treatment  must  be  symptomatic,  unless  the  nature  of  the  poison  is 
known. 


CHAPTER   II 

HEMORRHAGES 

In  capillary  hemorrhage  there  is  a  steady  oozing  of  red  blood  from 
all  over  the  wounded  surface ;  nature's  method  of  arresting  such  a 
hemorrhage  is  by  the  coagulation  or  clotting  of  the  blood  in  the 
mouths  of  the  tiny  vessels,  and  by  the  contraction  of  their  cut  ends. 
In  treatment  we  imitate  nature.  The  part  should  be  elevated  and 
very  hot  or  very  cold  water  applied  to  the  wound ;  the  effect  of  either 
one  is  the  same  as  the  other,  the  result  being  the  contraction  of  the 
vessels,  coagulation  of  the  blood,  and  arrest  of  hemorrhage. 

After  this,  uniform  pressure  applied  to  the  wound  by  means  of  a 
gauze  compress  and  bandage  is  all  that  is  required. 

Epistaxis  or  nose-bleed  is  a  form  of  capillary  hemorrhage  which 
is  sometimes  difficult  to  control;  the  arms  should  be  held  by  an 
assistant  vertically  above  the  head,  and  a  sponge  dipped  in  cold  water 
applied  to  the  back  of  the  neck  between  the  shoulders,  and  another 
over  the  root  of  the  nose ;  very  cold  or  very  hot  water  should  be 
snuffed  up  the  nose;  if  this  fails  an  astringent  should  be  added  to 
the  water  —  alum  or  tannic  acid.  Should  the  bleeding  still  continue, 
plug  the  nostrils  with  absorbent  cotten ;  but  if  the  blood  then  runs 
into  the  throat  from  the  back  of  the  nose,  the  assistance  of  a  surgeon 
will  be  required. 

Capillary  bleeding  from  a  tooth  socket  is  sometimes  excessive; 
plug  the  cavity  with  a  narrow  strip  of  gauze,  place  a  compress  over 
the  gauze,  and  bandage  the  lower  jaw  firmly  against  the  upper. 

In  venous  hemorrhage  there  is  a  rapid  flow  of  dark  blood,  a  welling 
up  as  it  were,  without  any  spurting.  In  the  treatment  the  first  step 
is  to  elevate  the  part ;  so  little  velocity  is  there  in  the  venous  current 
that  elevation  alone  will  often  stop  the  bleeding;  if  it  does  not, 
pressure  must  be  made  directly  over  the  wound,  and  hot  or  cold 
water  may  be  applied  if  necessary ;  if  in  an  extremity,  the  limb  should 
be  bandaged  from  the  toes  or  fingers  up  to  the  bleeding  point,  in 
addition  to  the  pressure  over  the  point. 

(96) 


HEMORRHAGES 


97 


In  arterial  hemorrhage  the  blood  is  bright  red  in  color  and  escapes 
in  jets.  Nature's  method  of  arresting  such  a  hemorrhage  is  by  the 
formation  of  a  clot,  the  contraction  of  the  muscular  coat  of  the  artery 
lessening  the  caliber,  and  the  retraction  of  the  middle  and  inner  coats 
affording  an  obstacle  to  the  escape  of  the  blood  and  favoring  clot  for- 
mation, and  the  diminished  force  of  the  blood  flow  caused  by  the 
weakening  of  the  heart's  action,  the  result  of  the  hemorrhage. 

When  fainting  follows  the  loss  of  blood  the  hemorrhage  often 
ceases  at  once  because  the  heart's  action  is  so  weak  that  it  cannot 
force  out  the  clot  which 
forms  in  the  mouth  of 
the  vessel;  in  such  a 
case,  however,  the  bleed- 
ing  is  apt  to  start  again 
when  reaction  takes 
place,  or  when  some 
sudden  movement  dis- 
places the  clot.  The 
recurrence  of  bleeding 
with  reaction  is  known 
as  intermediate  hemor- 
rhage to  distinguish  it 
from  primary  hemor- 
rhage, that  which  occurs 
immediately  on  receipt 
of  the  wound,  and 
secondary,  that  which 
occurs  at  a  still  later  period  from  the  reopening  of  the  artery  by  the 
slipping  of  a  ligature,  or  from  an  extension  of  sloughing  or  ulcera- 
tion to  the  vessel. 

In  the  treatment  of  arterial  hemorrhage  prompt  action  is  required ; 
bleeding  from  a  large  artery  like  the  femoral  may  cause  death  in  a 
minute  or  two ;  as  a  matter  of  fact  a  large  proportion  of  the  deaths 
on  the  battlefield  are  due  to  hemorrhage. 

The  thing  to  be  done  is  to  compress  the  artery  between  the  wound 
and  the  heart,  or  if  that  cannot  be  done  then  in  the  wound  itself;  the 
point  selected  for  pressure  should  be  where  the  artery  crosses  a  bone 
because  there  it  can  be  made  most  effective.  If  a  hose  connected 
with  a  hydrant  breaks  we  stop  the  flow  of  water  by  putting  a  foot 
7 


Fig.   43. —  Compression   of  the   Femoral   Artery. 


98 


FIRST  AID 


upon  the  hose  between  the  broken  part  and  the  hydrant ;  we  apply 
the  same  principle  in  arterial  hemorrhage.  The  pressure  should  be 
made  with  the  fingers,  preferably  the  thumbs,  and  should  be  firm 
enough  to  arrest  the  bleeding  (Fig.  43)  ;  it  should  be  made  over  the 
clothes,  as  too  much  time  may  be  lost  in  removing  them.     You  will 

know  that  you  are  pressing  on  the 
right  place  by  feeling  the  artery  beat- 
ing beneath  the  fingers  and  by  the 
arrest  of  the  bleeding;  if  you  cannot 
find  the  artery  make  pressure  directly 
over  the  bleeding  point.  As  pressure 
with  the  fingers  soon  becomes  tire- 
some, get  an  assistant  to  slip  his 
thumb  over  yours,  and  take  your 
place  while  you  prepare  a  tourniquet. 
The  principle  of  all  tourniquets  is  a 
pad  over  the  artery  to  bring  the  pres- 
sure on  the  artery  and  take  it  ofif  the 
veins,  a  band  around  the  limb  and 
over  the  pad,  and  some  means  of 
tightening  the  band.  There  are  a 
number  of  special  tourniquets,  but  as 
they  are  not  usually  at  hand  a  suitable  one  must  be  improvised ;  an 
excellent  tourniquet  may  be  improvised  with  a  rubber  bandage;  a 
number  of  turns  are  made  about  the  limb  and  the  rolled  portion  of 
the  bandage  then  placed  under  the  last  turn  in  such  a  position  as  to 
press  directly  upon  the  artery  (Fig. 
44).  The  most  common  improvised 
tourniquet  is  the  Spanish  windlass; 
in  this  arrangement  any  rounded, 
smooth,  hard  object,  such  as  a  stone, 
a  cork,  or  a  roller  bandage,  is  used  as 
a  compress ;  for  the  band  a  handker- 
chief, a  suspender,  a  waistbelt,  a 
bandage,  or  anything  of  the  sort  may 
be  used;  to  tighten  up  the  band  a 
stick  or  bayonet,  scabbard  or  some- 
thing of  the  kind  is  passed  under 
the     band     and     twisted     until     the         v,r.     .     =     ■  u  w  a, 

Fig.   45. —  Spanish   Windlass. 


Fig.  44. — Compression  of  the  Femorral 
Artery  by  a  Rubber  Bandage. 


HEMORRHAGES 


99 


bleeding  ceases,  when  the  ends  of  the  stick  are  tied  to  the  Hmb  to 
prevent  the  band  from  becoming  untwisted  (Fig.  45).  A  tourniquet 
applied  tight  enough  to  stop  arterial  hemorrhage  causes  pain  and 
swelling  of  the  limb,  and  if  left  long  enough  may  cause  gangrene  of 
the  part;  it  should  therefore  be  watched  and  loosened  up  from  time 
to  time,  say  every  half-hour  or  so.     If  on  loosening  the  tourniquet 

the  bleeding  starts  again  tighten 
it  up;  if  there  is  no  appearance 
of  bleeding  leave  the  loose  tourni- 
quet in  place  with  an  attendant 
watching  to  tighten  it  up  should 
the  hemorrhage  recur. 

The  surgeon  arrests  the  hem- 
orrhage permanently  by  tying  or 
twisting  the  divided  ends  of  the 
artery. 

Fig.  46  shows  on  the  skeleton 
the  points  at  which  the  various 
arteries  may  be  compressed  to 
the  best  advantage. 

For  bleeding  anytvhere  in  the 
upper  extremity  below  the  mid- 


Fic.  46. —  Skeleton  with  Black  and  Dotted 
Lines  Showing  the  Course  of  the  Arteries 
and  a   x   Indicating  the  Pressure  Points. 


Fig.  47. —  Compression  of  the  Brachial 
Artery. 


die  of  the  arm  compress  the  brachial  in  the  manner  shown  in  Fig.  47 
and  then  apply  a  tourniquet  a  little  higher  up.     If  the  wound  is 


100 


FIRST  AID 


low  down  in  the  palm  of  the  hand,  it  may  not  be  desirable  to 
arrest  the  circulation  in  the  entire  limb,  in  which  case  the  pressure 
may  be  made  in  the  palm  by  a  roller  bandage  over  which  the  fingers 
are  doubled  and  tied  in  place  with  a  bandage   (Fig,  48)  ;  or  we 


Fig.  48. —  Arrest  of  Bleeding  from  the  Palm. 

may  put  a  pad  in  the  elbow  and  bend  the  forearm  on  the  arm  and 
tie  the  two  together  (Fig.  49). 

If  the  wound  is  in  the  axilla,  pressure  must  be  made  on  the  sub- 
clavian against  the  first  rib  and  in  the  hollow  behind  the  clavicle 


Fig.  49. —  Flexion  of  the  Elbow  to 
Arrest   Bleeding  Below. 


Fig.  so. —  Compression  of  the  Sub- 
clavian Artery. 


(Fig.  50)  ;  as  a  tourniquet  cannot  be  applied  here  the  fingers  may  be 
relieved  by  making  the  pressure  with  the  handle  of  a  large  key,  or 
the  end  of  a  pocket  knife  well  wrapped. 

In  bleeding  from  any  part  of  the  loz(/er  extremity  compress  the 


HEMORRHAGES 


101 


femoral  against  the  head  of  the  femur  just  below  the  middle  of  the 
groin,  with  both  thumbs,  as  shown  in  Fig.  43,  then  apply  a  tourni- 
quet to  replace  the  thumbs. 

U  the  bleeding  is  from  the  foot  another  method  is  to  put  a  pad  be- 
hind the  knee  and  flexing  the  leg  forcibly,  tie  the  leg  to  the  thigh  as 


Fig.  51. —  Arrest  of  Bleeding  by  Flexion  of  the  Knee. 

shown  in  Fig.  51 ;  if  from  the  top  of  the  foot  a  tourniquet  may  be 
placed  over  the  anterior  tibial  in  front  of  the  ankle,  or  if  from  the 
sole  of  the  foot  over  the  posterior  tibial  behind  the  inner  ankle. 


Fig.    52. —  Compression  of  the  Carotid. 


F13.  S3- —  Compression  ot 
the  Temporal  Artery  by 
Knotted  Bandage. 


Hemorrhage  of  the  neck  from  the  branches  of  the  carotid  is  con- 
trolled by  compression  of  the  carotid  with  the  thumb  against  the  ver- 
tebrae (Fig.  52)  ;  a  tourniquet  cannot  be  applied  here. 


102  FIRST  AID 

Bleeding  from  the  tongue  may  be  controlled  in  the  same  way,  or 
by  rinsing  the  mouth  out  with  ice  water,  or  holding  pieces  of  ice  in 
the  mouth. 

Bleeding  from  the  lips  may  be  very  severe;  it  is  controlled  by 
grasping  the  lip  between  the  thumb  and  fingers;  as  the  arteries  of 
the  lip  come  from  both  sides,  pressure  must  be  made  on  both  sides  of 
the  wound. 

Bleeding  from  the  face  may  be  arrested  by  pressure  on  the  facial 
artery  in  front  of  the  angle  of  the  jaw. 

Bleeding  from  the  scalp  is  easily  arrested  by  pressure  with  a  com- 
press on  the  bleeding  point,  the  pressure  being  made  by  a  knotted 
bandage  as  shown  in  Fig.  53. 

In  bleeding  from  the  lungs  the  blood  is  bright  red,  frothy,  perhaps 
mixed  with  mucus,  and  is  coughed  up.  Listen  over  the  chest  and 
where  rattling  is  heard  apply  an  ice  bag;  give  the  patient  pieces  of 
ice  to  swallow,  and  keep  him  perfectly  quiet  in  the  recumbent  posi- 
tion ;  he  should  neither  talk  nor  move. 

In  bleeding  from  the  stomach  the  blood  is  vomited,  is  usually  dark 
in  color,  and  may  be  mixed  with  food.  It  is  always  well  to  remember 
that  vomited  blood  does  not  necessarily  indicate  hemorrhage  from 
the  stomach ;  the  blood  may  have  been  swallowed,  coming  from  the 
back  of  the  nose  or  throat ;  inquire  whether  there  has  been  any  nose- 
bleed. The  treatment  is  the  same  as  for  hemorrhage  from  the 
lungs,  except  that  the  ice  bag  is  applied  over  the  stomach. 

In  bleeding  from  the  bozcels  the  blood  is  bright  red  if  fresh ;  black 
and  tarry  if  old.  All  that  can  be  done  is  to  apply  cold  applications  to 
the  abdomen  and  keep  the  patient  quiet. 


CHAPTER    III 

DISLOCATIONS    AND   SPRAINS 

A  dislocation  is  a  permanent  slipping  away  from  each  other  of  the 
bones  which  form  a  joint,  with  locking  of  the  bones  in  the  new  posi- 
tion ;  the  joint  is  out  of  place.  Necessarily  the  dislocation  is  attended 
with  tearing  of  the  ligaments  and  often  with  rupture  of  the  muscular 
attachments  as  well. 

The  cause  is  usually  indirect  violence  especially  falls  and  twists. 
In  attempting  to  save  one's  self  from  falling  the  hand  is  thrown  out 
and  the  weight  of  the  body  coming  on  it  causes  a  dislocation  of  the 
shoulder ;  or  the  thigh  in  falling  is  bent  backward,  resulting  in  dislo- 
cation of  the  hip. 

The  symptoms  of  dislocation  are  as  follows  :  The  patient  has  fallen 
and  cannot  move  the  affected  joint;  there  is  pain  of  a  sickening  char- 
acter, often  with  numbness  or  tingling  in  the  limb  below  from  pres- 
sure on  the  nerves  and  blood-vessels ;  on  attempting  to  move  the  joint 
we  find  that  it  is  locked  and  cannot  be  moved ;  on  uncovering  and 
examining  it,  it  will  be  noticed  that  there  is  marked  deformity  in  the 
joint,  and  that  the  limb  is  fixed  in  an  unnatural  position,  and  appears 
longer  than  the  corresponding  limb  on  the  other  side. 

A  dislocation  must  always  be  carefully  distinguished  from  a  frac- 
ture or  a  sprain.  In  fracture  there  is  unnatural  movement  between 
the  joints  instead  of  immobility  at  the  joint,  and  the  movement  is 
attended  with  a  grating  sensation  and  sound;  the  deformity  is  be- 
tween the  joints  and  there  is  usually  shortening  of  the  limb. 

In  sprains  there  is  absence  of  any  of  the  signs  of  dislocation  except 
swelling  and  pain ;  the  joint  can  be  rnoved,  though  the  patient  will 
resist  on  account  of  the  pain.  Always  uncover  the  limbs  and  com- 
pare the  corresponding  joints  on  the  two  sides. 

If  the  services  of  a  surgeon  can  soon  be  obtained  nothing  should 
be  done  for  dislocations  except  to  loosen  the  clothing  about  the  in- 
jured part  and  support  it  as  comfortably  as  possible  in  the  new  po- 
sition. If  the  patient  must  be  moved  the  limb  should  be  supported 
in  a  sling,  or  by  splints  and  bandages. 

(103) 


104 


FIRST  AID 


When,  however,  a  physician  can  not  be  reached  for  some  time, 
there  are  certain  dislocations  which  a  hospital-corps  man  may 
attempt  to  reduce.  He  must  always  remember  that  no  force  is  to 
be  employed,  as  it  may  do  serious  damage  to  the  important  vessels 
and  nerves  near  the  joint ;  the  secret  of  success 
lies  in  the  skillful  manipulation  with  a  clear 
understanding  of  the  anatomy  of  the  joint. 

Dislocation  of  the  shoulder  occurs  more  fre- 
quently than  dislocation  of  all  the  other  joints 
jn  the  body  taken  together;  the  reason  of  this 
has  been  explained  on  page  43 ;  the  most  common 
dislocation  of  the  shoulder  is  downward  (Fig. 
54).  The  symptoms  are  those  described  for  dis- 
locations in  general ;  there  will  be  a  hollow  under 
the  point  of  the  shoulder  which  will  be  very  con- 
spicuous when  compared  with  the  convexity  on  the  other  side  and 
the  head  of  the  bone  can  be  felt  in  the  arm  pit  where  it  should  not 


Fig.  54. —  Subgle- 
noid Dislocation  of 
the  Shoulder. 


Fig.  55. —  Reduction  of  Dislocation  of  the  Shoulder  by  the  Foot  in  the  Axilla. 


be.  To  reduce  this  dislocation  place  the  patient  on  his  back  on  the 
ground ;  sit  beside  him ;  remove  one  shoe  from  your  foot  and  place 
that  foot  in  the  patient's  axilla ;  -then  using  the  foot  as  a  fulcrum, 
draw  the  arm  downward  in  the  direction  of  its  axis,  then  outward, 
and  finally  carry  it  across  the  chest  (Fig.  55)  ;  or  Kocher's  method 


DISLOCATIONS  AND  SPRAINS  105 

may  be  tried  as  follows :  Flex  the  forearm  to  a  right  angle,  bring 
the  elbow  to. the  side;  carry  the  hand  and  forearm  outward;  then  lift 
up  the  elbow  and  sweep  the  forearm  across  the  front  of  the  chest. 
If  successful  the  humerous  will  suddenly  slip  into  place  with  a  click; 
the  arm  should  then  be  bandaged  to  the  side  for  a  week  or  two  to 
give  the  torn  ligaments  a  chance  to  heal.  If  unsuccessful  after  a 
few  minutes'  trial  further  attempt  should  be  postponed.  A  shoulder 
once  dislocated  is  usually  permanently  weak,  and  the  dislocation  is 
apt  to  recur  from  slighter  violence  than  at  first. 

In  dislocation  of  the  lozver  jazv  (Fig.  56)  the  patient  can  not  speak 
or  close  the  jaws,  and  is  in  great  distress. 

This  dislocation  is  usually  re- 
duced without  much  difficulty, 
but  there  is  great  danger  of  the 
thumbs  of  the  operator  being 
bitten.  Wrap  the  thumbs  well 
with  a  handkerchief  or  band- 
age; stand  in  front  of  the  pa- 
tient, and  while  pressing  with 
the   thumbs   in    the    mouth    just     cl\ 

back  of   the  last   lower  molars   at  ^"'-  56.— Dislocation  of  the  Lower  Jaw. 

the  same  time  with  the  fingers 

lift  up  the  chin ;  the  jaw  will  usually  at  once  snap  into  place,  and  the 

thumbs  must  be  quickly  withdrawn  to  prevent  them  being  bitten. 

After  reduction  bind  the  lower  jaw  to  the  upper  with  a  four-tail 

bandage. 

In  dislocation  of  the  finger  joints  pull  on  the  dislocated  end,  at  the 
same  time  bending  it  backward  if  the  dislocation  is  forward,  or  for- 
ward if  the  dislocation  is  backward,  and  pushing  the  joint  into  place. 
After  reduction  strap  or  splint  the  finger. 

The  patella  or  knee-cap  may  be  dislocated  outward  or  inward ; 
there  is  sickening  pain,  the  knee  cannot  be  moved,  and  on  examina- 
tion there  is  a  hollow  in  front  of  the  knee  where  there  should  be  full- 
ness, and  the  patella  can  be  seen  and  felt  in  its  new  position. 

Extend  the  knee  as  much  as  possible  and  ,flex  the  thigh  so  as  to 
relax  the  muscles,  when  the  patella  can  usually  be  pushed  into  place. 

In  sprains  the  joint  surfaces  slip  apart,  tearing  the  ligaments,  but 
slip  back  into  place  again ;  a  sprain  is  really  a  momentary  dislocation. 
The  tearing  of  the  ligametns  causes  hemorrhage  into  and  around  the 


106 


FIRST  AID 


joint,  and  as  the  blood  can  not  escape  externally  the  joint  is  immedi- 
ately swollen;  that  the  swelling  is  due  to  the  bleeding  is  shown  by 
the  black  and  blue  discoloration  of  the  skin  over  the  joint  which 
begins  to  appear  after  a  day  or  two  as  the  blood  comes  to  the 
surface. 

The  treatment  consists  in  stopping  the  hemorrhage,  causing  the 
absorption  of  the  blood  already  poured  cut,  and  supporting  the  joint 
until  the  ligaments  heal. 

A  sprained  ankle,  the  most  common  of  all  sprains,  may  be  taken 
as  a  type.     The  patient  twists  his  foot  stepping  on  a  stone,  there 

is  sharp  pain  in  the  ankle, 
lameness,  and  prompt  swell- 
ing of  the  joint,  but  the  joint 
is  movable,  thus  excluding 
dislocation,  and  there  is  an 
absence  of  the  signs  of 
fracture. 

To  central  the  bleeding  put 
the  foot  at  once  into  a  pail  of 
hot  water,  as  hot  as  can  be 
borne,  and  keep  it  there  ten 
minutes ;  or  if  there  is  no 
water  hot  enough  use  ice 
water.  Next  shave,  dry  and 
powder  the  foot  and  then 
strap  the  joint  firmly  with 
rubber  adhesive  plaster,  using 
strips  about  an  inch  wide  and 
fifteen  to  eighteen  inches 
long  (Fig.  57).  The  first  strap  should  form  a  stirrup  of  the  heel, 
closely  following  the  tendo  Achillis  on  each  side ;  the  second  should 
cross  the  first  at  a  right  angle,  extending  along  the  border  of  the 
foot  from  the  root  of  the  little  toe  to  the  root  of  the  great  toe  or 
vice  versa;  the  third  strap  covers  one-third  of  the  first  and  the  fourth 
one-third  of  the  second  and  so  on  until  the  entire  ankle  is  covered 
except  a  narrow  strip  in  front  which  is  left  open  to  allow  of  free  cir- 
culation. Each  strap  is  drawn  tight  and  the  crossings  are  made 
strongest  over  the  swelling.  When  the  strapping  is  completed  a 
bandage  is  applied  over  all  until  the  plaster  is  firmly  adherent,  when 


Fig.    57. —  Strapping  the   Ankle. 


DISLOCATIONS  AND  SPRAINS  107 

the  bandage  is  removed,  the  sock  and  shoe  put  on  and  the  latter 
firmly  laced,  after  which  the  patient  should  begin  to  walk,  commenc- 
ing with  a  crutch  or  cane. 

The  walking  is  at  first  very  painful,  but  must  be  persisted  in,  as 
the  plaster  takes  the  place  of  the  torn  ligaments  and  the  movement  of 
the  joint  in  walking  causes  rapid  absorption  of  the  blood.  As  the 
strapping  becomes  loose  it  must  be  reapplied  after  thorough  massage 
of  the  joint. 


CHAPTER   IV 


Fig.   58. —  Green-stick  Fracture. 


FRACTURES 

A  fracture  is  a  broken  hone.     There  are  two  great  classes  of  frac- 
tures, simple  or  closed  and  compound  or  open. 

A  compound  or  open  fracture  is  one  in  which  there  is  a  wound 

communicating  with  the  broken  ends  of  the  bone ;  the  broken  bones 

are  open  to  infection,  A 
simple  or  closed  fracture  is 
one  in  which  the  broken  bones 
are  closed  to  the  air  and  to 
infection  in  that  there  is  no 
wound  communicating  with 
the  fracture. 
A  fracture  is  comminuted  when  the  bone  is  broken  into  more  than 

two  pieces;  complicated  when  there  are  also  injuries  to  the  adjoining 

vessels,  nerves,  or  muscles;    impacted  when  the  broken  ends  are 

driven  into  each  other  so  that  they  can  not  move ;  green  stick  when 

the  bone  is  bent  and  only  partially  broken  as  a  green  stick  is  broken 

(Fig.  58). 
Fractures  are  caused  by  direct  violence,  as  when  a  wagon  wheel 

passes  over  a  limb  and  breaks  it ;   indirect  violence,  as  when  a  man 

falls  on  his  hand  and  breaks  his  collar  bone;    muscular  action,  as 

when  one  breaks  his  arm  throwing  a  ball. 
How  will  you  know  that  a  fracture 

has  occurred?     First  there  is  a  loss  of 

power  in  the  part;   if  the  leg  is  broken 

the  man  has  fallen  and  can  not  get  up ; 

if  it  is  the  arm  he  can  not  use  it.    Then 

the  limb  is  in  an  unnatural  position;  if 

you  compare  it  with  the  uninjured  limb 

you  will  see  that  there  is  a  deformity 

between  the  joints,  and  that  the  injured  limb  is  probably  shorter. 

If  you  attempt  to  move  the  limb  you  find  there   is   movement 

(108) 


Fig.  59. —  Union  of  a  Fracture. 


FRACTURES 


109 


between  the  joints  where  there  should  be  none,  and  you  can  both  feel 
and  hear  the  broken  ends  of  the  bone  grating  together crepitus. 

The  patient  complains  of  great  pain  and  tenderness  at  the  seat  of 
fracture  and  there  is  swelling  there  due  to  bleeding  from  the  broken 
ends.  There  is  a  history  of  violence  and  often  the  patient  will  say 
that  he  heard  the  bone  crack  and  give  way. 

In  the  treatment  of  fractures  the  great  point  is  to  keep  them  from 
becoming  open ;  a  closed  fracture  is  a  very  simple  matter,  not  danger- 
ous to  life,  and  usually  healing  promptly  if  kept  quiet  in  proper  po- 


FiG.  60. —  Use  of  Wire  Gauze  as  a  Splint. 

sition ;  an  open  fracture  is  quite  another  matter,  always  taking  a  long 
time  to  heal  and  often  threatening  loss  of  limb  and  even  life  from 
infection. 

Therefore  never  attempt  to  move  a  man  with  a  fracture  until  the 
fracture  has  been  fixed  so  that  the  broken  ends  of  the  bone  can  not 
move.  If  a  physician  can  be  obtained  at  once  merely  make  the 
patient  comfortable  with  pillows  and  supports  where  he  lies;  if  he 
must  be  moved  apply  splints,  handling  the  broken  bones  very  care- 
fully so  that  sharp  ends  may  not  come  through  the  skin  and  make  the 
fracture  compound.  If  a  physician  can  not  be  reached  for  a  day  or 
two  set  the  fi;ficture  and  then  splint  it. 


no 


FIRST  AID 


The  cause  of  deformity  in  fractures  is  muscular  contraction,  and 
this  contraction  must  be  overcome  in  setting  the  fracture,  which  is 
merely  getting  the  broken  ends  into  proper  position ;  this  is  done  by 
extension  and  counter-extension ;  extension  is  pulling  the  far  end 
of  the  limb,  and  counter-extension  is  merely  holding  the  end  next 
the  trunk ;  pull  until  the  deformity  and  shortening  disappear  and  the 


Fig.  6i. —  Splints  of  Telegraph  Wire. 

two  limbs   look   alike,   then   hold  them   so   while   the   sphnts   are 
applied. 

When  a  fracture  is  properly  set  the  blood  which  escaped  into  the 
tissues  about  the  break  is  gradually  absorbed  and  at  the  end  of  a 
week  or  ten  days  callus  is  thrown  out  or  the  limb  begins  to  knit; 
calus  is  a  soft,  cement-like  substance  which  is  poured  out  between 
the  broken  ends  around  them,  and  in  the  medullary  cavity ;  the  callus 
gradually  hardens  into  bone.  That  which  is  around  the  break  form- 
ing a  sort  of  ferrule  or  splice,  and  that  in  the  medulla  forming  a  pin, 
are  absorbed  after  many  months ;  but  that  between  the  bones  remains 


FRACTURES 


111 


permanently,  knitting  the  bone  together  (Fig.  59).  Sometimes  the 
callus  IS  not  sufficient  in  quantity  or  quality  and  union  fails  to  take 
place. 

When  a  fracture  is  already  open  or  compound  the  object  of  treat- 
ment is  to  convert  it  into  a  simple  fracture,  or  at  least  to  prevent  in- 
fection.    The  wound  is  first  dressed  and  then  the  fracture  is  treated. 

A  splint  is  merely  a  splice  to  hold  the  bones  in  proper  position 
until  nature  unites  them.  Splints  must  be  light  but  sufficiently  rigid 
to  prevent  bending;  long  enough  to  fix  the  joints  above  and  below 
the  fracture;  broad  enough  to  prevent  pinching  of  the  limb  in  band- 
aging; sufficiently  padded  to  protect  the  part  from  undue  pressure. 


Fig.  62. 


Fig.  63. 


There  are  many  splint  materials  supplied,  among  the  more  com- 
mon being  thin  boards,  cardboard,  felt,  leather,  wire  gauze  (Fig.  60), 
etc.  Often  in  the  military  service  splints  must  be  extemporized;  one 
of  the  most  useful  and  most  accessible  materials  for  preparing  them 
is  telegraph  wire ;  the  method  of  using  it  is  illustrated  in  the  figures 
(Fig.  61 ) .  On  the  battlefield  the  various  weapons  may  be  employed  : 
rifles,  bayonets,  swords,  scabbards  (Fig.  62),  and  tent  pins;  splints 
may  also  be  prepared  from  blankets  and  straw,  from  hay,  small 


112 


FIRST  AID 


§ticks,  the  bark  of  trees,  barrel  staves,  broom  handles,  canes  and 
umbrellas. 

Padding  may  be  made  of  clothing,  hay,  straw,  grass,  leaves,  excel- 
sior, cotton,  crumpled  paper,  etc. 

The  best  things  to  hold  splints  in  place  are  straps  which  can  be 
readily  buckled  and  unbuckled ;  the  next  best  is  the  loop  bandage 
applied  as  shown  in  Fig.  64;  roller  bandages,  triangular  bandages, 
tape,  and  many  other  things  may  be  used.  Before  the  splints  are 
applied  permanently  the  limb  is  usually  bandaged  from  the  extremity 
up  to  the  fracture  in  order  to  prevent  swelling  below ;   after  the  ap- 


plication of  the  splints  another  bandage  is  applied  over  all.  Be 
careful  not  to  make  the  dressing  too  tight,  and  always  leave  the  tips 
of  the  fingers  exposed  so  that  the  circulation  may  be  watched.  If  the 
tips  of  the  fingers  are  blue  and  cold,  or  if  upon  pressing  the  blood  out 
from  under  the  nails  it  does  not  quickly  return  the  dressing  is  too 
tight. 

After  splinting  the  upper  limb  it  must  be  placed  in  a  sling;    if 
there  are  no  materials  available  to  form  one,  the  coat  sleeve  may  be 


FRACTURES 


113 


simply  pinned  to  the  coat,  or  the  flap  of  the  blouse  may  be  turned  up 
and  pinned,  ripping  the  seam  if  necessary  (Figs.  65  and  66). 

Fractures  of  the  skull  and  spinal  column  are  chiefly  of  importance 
on  account  of  the  coincident  injury  to  the  important  parts  of  the  ner- 
vous system  which  lie  immediately  beneath  the  bone.  In  fractures  of 
the  skull,  unless  compound  or  depressed,  all  the  usual  symptoms  of 
fracture  are-  absent,  or  entirely  overshadowed  by  the  injury  to  the 


Fig.  65. 


Fig.  66. 


brain.  The  most  prominent  brain  symptoms  are  loss  of  conscious- 
ness and  paralysis;  if  the  loss  of  consciousness  is  sudden  it  is 
probably  due  to  the  pressure  of  a  piece  of  bone ;  if  it  comes  on  slowly 
it  is  apt  to  be  the  result  of  hemorrhage  from  a  torn  vessel.  In  frac- 
tures of  the  base  of  the  skull  there  may  be  bleeding  from  the  nose 
or  ears,  or  into  the  orbits  and  under  the  conjunctiva ;  the  escape  of 
8 


114 


FIRST  AID 


cerebro-spinal  fluid  —  a  clear,  watery  serum  —  from  the  ears  is  con- 
sidered a  sure  sign  of  fracture  of  the  base. 

Treatment:    Keep  the  patient  quiet  in  a  recumbent  position  and 

apply  an  ice  bag  to  the  head ;  if  the  fracture  is  compound  a  dressing 

will  be  required. 

In  fractures  of  the  spinal  column  the  spinal  cord  is  generally  in- 
jured or  cut  across,  with  resulting  paralysis 
of  all  parts  below  the  fracture.  On  ex- 
amination, irregularity  of  the  spinous  pro- 
cesses will  be  noted,  usually  with  angular 
deformity.  Handle  the  patient  with  great 
care  so  as  not  to  produce  or  increase  injury 
to  the  spinal  cord.  Before  moving  him 
apply  splints  on  both  sides,  from  his  arm- 
pits to  his  feet,  so  as  to  make  the  body  as 
rigid  as  possible,  then  work  a  blanket  under 
him,  and,  drawing  it  as  tight  as  possible, 
lift  him  on  a  litter. 

Frdctures  of  the  ribs  and  pelvis  are  also 
chiefly  important  on  account  of  the  injury 

to  the  contained  viscera. 

In  fracture  of  the  ribs  the  sharp  end  of  the  bone  is  apt  to  stick  into 

the  lung  every  time  the  patient  breathes;    hence  in  these  cases  the 

patient   will   often    complain   of   a   sharp   pain   when   he   breathes, 

and   there    may   be    cough,    with    spitting   of 

frothy  blood.     When  the  fingers  are  passed 

firmly  along  the  ribs  they  may  be  felt  to  give 

at  the  broken  point,  which  is  also  very  tender. 
The    treatment    consists    in    confining    the 

movements  of  that  side  of  the  chest  as  much 

as  possible,  in  order  to  give  the  broken  bone  an 

opportunity  to  rest  and  knit.     This  is  done  by 

circular  bandaging  of  the  whole  chest  or  by 

strapping  one  side. 

The  pelvis  is  so  strong  that  the  bones  are 

broken  only  by  the  most  severe  direct  violence, 

as  when  a  heavy  wagon  passes  over  it.     The 

symptoms  are  inability  to  stand  or  sit  up,  and  crepitus  may, be  felt 

when  firm  pressure  is  made.     If  there  is  an  injury  to  the  bladder  the 


Fig.  67. —  Four-tail  Bandage 
for  Fracture  of  Jaw. 


Fig.  68. 


FRACTURES 


115 


urine  contains  blood.  The  treatment  consists  in  the  application  of 
splints  on  both  sides  from  the  axillse  to  the  feet ;  if  the  bladder  is 
injured  a  catheter  must  be  introduced  and  left  in,  so  that  the  urine 
will  not  accumulate  and  escape  into  the  peritoneal  cavity. 

In  fracture  of  the  nasal  bones  there  is  usually  considerable  deform- 
ity, the  bridge  of  the  nose  being  caved  in  and  pushed  to  one  side; 
crepitus  is  generally  to  be  felt,  and  there  is  considerable  nose-bleed! 

Check  the  bleeding  by  syringing 
with  hot  or  cold  water;  push  the 
bones  into  place  by  means  of  a  probe 
or  slender,  smooth  stick  in  the  nostril, 
aided 'by  the  fingers  outside.  Apply 
cold  dressings  over  the  bridge  of  the 
nose  and  warn  the  patient  not  to 
attempt  to  blow  the  nose. 

In  fracture  of  the  loiver  jaw  the 
line  of  teeth  is  irregular  and  there 
may  be  bleeding  from  the  mouth ;  the 
patient  can  not  open  his  mouth,  and 
the  fracture  can  usually  be  readily 
felt.  ^'°-  ^9. 

Push  the  bones  into  place  and  apply  a  four-tailed  bandage  (Fig. 
67)  or  two  narrow  cravats.  The  patient  can  not  chew  and  will  have 
to  live  for  a  time  on  liquid  foods  taken  through  a  tube. 

In  fracture  of  the  clavicle  the  attitude  of  the  patient  is  often  char- 
acteristic; the  shoulder  drops  downward,  inward  and  forward,  and 
he  attempts  to  support  it  by  holding  the  elbow  of  the  injured  side  in 
the  hand  of  the  sound  side.  The  collar  bone  lying  immediately  under 
the  skin,  the  fracture  is  easily  made  out. 

As  a  first-aid  dressing,  put  the  arm  in  a  large  sling,  place  a  pad 
in  the  axilla,  and  bind  the  arm  to  the  side.  The  fracture  is  put  up 
permanently  in  a  Sayre's  dressing  or  a  Velpeau  bandage. 

Fracture  of  the  humerus  or  arm  bone 
has  all  the  common  signs  of  fracture  and 
may  ordinarily  be  recognized  without  diffi- 
culty. Two  splints  are  required;  they 
should  be  placed  on  the  inner  and  outer 
sides,  except  in  fracture  near  the  lower  end  of  the  bone,  when  the 
splints  should  be  front  and  rear  (Fig.  68). 


Fig.  70. —  Colles'  Fracture. 


116  FIRST  AID 

If  the  fracture  is  near  the  shoulder  joint  a  shoulder  cap  must  also 
be  used,  and  if  near  the  elbow  joint  the  inner  splint  should  be  rectan- 
gular and  include  the  forearm.  The  wrist  should  be  supported  in  a 
sling,  leaving  the  elbow  hanging  down  so  as  to  produce  extension. 
If  no  splints  are  available  the  arm  should  be  at  least  bandaged  to  the 
side  or  placed  in  a  sling. 

When  both  bones  of  the  forearm  are  broken  all  the  usual  signs  of 
fracture  are  present.  Place  a  splint  on  each  side,  from  the  elbow  to 
the  root  of  the  fingers,  and  put  the  arm  in  a  sling  (Fig.  69). 

As  a  general  rule,  in  all  fractures  of  the  upper  extremity  flex  the 
elbow  to  a  right  angle,  and  place  the  forearm  in  such  a  position  that 
the  thumb  will  point  up. 

The  reason  of  this  is,  that  should  the  elbow  become  stiff,  the  arm 
is  more  useful  in  that  position  than  any  other;  the  thumb  should 
point  up,  that  is,  the  forearm  be  midway  between  pronation  and 
supination,  for  in  that  position  there  is  the  widest  possible  space 
between  the  radius  and  ulna,  and  therefore  they  are  less  apt  to 
become  fused  together  by  the  callus  which  is  thrown  out  in  the 
process  of  union. 

Fracture  of  the  radius  alone,  just  above  the  wrist,  is  very  common 
and  is  known  as  Colles'  fracture.     It  is  attended  by  a  peculiar  silver- 


FiG.   71.  * 

fork  deformity  (Fig.  70),  and  as  the  bones  are  usually  impacted, 
crepitus  is  absent.  The  setting  of  this  fracture  can  only  be  properly 
done  by  a  surgeon ;  meantime  the  arm  should  be  placed  in  a  sling. 

Fracture  of  the  metacarpals  —  a  broken  hand  —  usually  occurs  in 
a  fight.  The  most  prominent  signs  are  deformity  and  pain.  Splints 
should  be  applied  on  the  back  and  front  of  the  hand,  reaching  from 
the  finger  tips  half-way  up  the  forearm. 

Fractures  of  the  fingers  are  treated  by  the  application  of  narrow 
finger  splints,  usually  on  the  palmar  surface  only. 

In  fractures  of  the  femur  all  the  common  symptoms  of  fractures 


FRACTURES 


117 


are  usually  present ;  the  foot  may  be  everted,  lying  on  its  outer  side, 
and  the  leg  is  shorter  than  the  other.  Two  splints  must  be  applied ; 
the  one  on  the  outside  reaches  from  the  armpit  to  beyond  the  foot ; 
the  one  on  the  inside  from  the  crotch  to  the  foot  (Fig.  71).  The 
splints  should  be  tied  on  in  five  places :  around  the  ankles,  over  the 
knees,  just  below  the  hips,  around  the  pelvis,  and  just  below  the 
axilla.     It  is  well  also  to  tie  the  two  limbs  together. 


Fig.  72. —  Dressing  for  Broken  Knee-Cap. 


So  powerful  are  the  muscles  of  the  thigh,  constantly  tending  to 
make  the  bones  overlap,  that  in  the  permanent  treatment  in  hospitals 
it  is  customary  to  provide  special  arrangements  for  overcoming  the 
muscular  action. 

These  arrangements  comprise  what  is  called  extension.  A  weight 
is  attached  to  the  foot  by  adhesive-plaster  straps,  and  a  cord  run- 
ning over  a  pulley,  and  counter-extension  is  provided  by  raising  the 
foot  of  the  bed,  thus  utilizing  the  weight  of  the  body. 

Fractures  of  the  lower  extremity  are  always  put  up  with  the  entire 


limb  straight,  so  that  if  the  joints  get  stiff  the  limb  can  be  at  least 
utilized  for  standing  and  walking. 

In  fractures  of  the  patella  or  knee-cap  the  patient  can  not  stand  or 
walk;  the  upper  fragment  is  drawn  up  the  thigh  by  the  powerful 
muscles  attached  to  it,  and  the  gap  can  be  readily  felt.  The  joint 
swells  up  at  once.     A  splint  should  be  applied  to  the  back  of  the  knee 


118  FIRST  AID 

so  as  to  keep  the  limb  extended,  and  the  upper  fragment  should  be 
brought  down  by  figure-of-eight  bandaging  (Fig.  'j2'). 

If  both  bones  of  the  leg  are  broken  the  fracture  is  very  apt  to  be 
compound  because  fracture  of  the  tibia  is  usually  oblique  with  a 
sharp  point  that  may  come  through  the  skin ;  such  a  fracture  should 
be  handled  with  the  greatest  care.  Apply  splints  from  the  knee  to 
beyond  the  foot  on  the  inside,  outside,  and  behind  (Fig.  73).  Tie 
the  feet  together. 

Fracture  of  the  fibula  alone  just  above  the  ankle  is  called  Pott's 
fracture,  the  signs  are  usually  indistinct,  but  if  the  lower  end  of  the 
tibia  is  fractured  as  well  there  is  apt  to  be  marked  eversion  of  the 
foot. 

Treat  in  the  same  manner  as  a  fracture  of  both  bones,  except  that 
the  posterior  splint  is  not  necessary. 

Fractures  of  the  bones  of  the  foot  are  best  treated  by  a  plaster-of- 
Paris  dressing. 


CHAPTER  V 

FOREIGN   BODIES 

In  the  eye:  Foreign  bodies,  such  as  particles  of  dust,  cinders,  etc., 
may  lodge  under  the  lids,  upon  the  conjunctiva,  or  upon  the  cornea. 
In  the  latter  situation  they  are  seen  and  removed  with  the  greatest 
difficulty,  and  the  removal  should  not  ordinarily  be  attempted  by 
other  than  a  physician.  To  remove  a  foreign  body  from  the  eye  the 
best  improvised  appliance  and  one  that  is  nearly  always  at  hand  is  a 
match.  Light  the  match  and  after  it  has  burned  a  moment  blow  it 
out;  then  with  a  clean  handkerchief  and  a  circular  movement  of  the 
fingers  wipe  off  the  charred  end,  leaving  a  soft,  aseptic,  splinterless 
point  with  which  to  remove  the  foreign  body. 


Fig.   74. —  Eversion  of  the  Upper  Eyelid. 


To  examine  the  lower  lid  draw  it  down  with  the  fingers,  at  the 
same  time  telling  the  patient  to  look  up ;  if  the  foreign  body  is  not 
found  there,  evert  the  upper  lid  (Fig.  74)  by  standing  behind  the 
patient  with  his  head  upon  your  chest  and  telling  him  to  look  down 
at  his  feet ;  at  the  same  time  press  a  match  or  the  end  of  the  finger 
firmly  against  the  outside  of  the  lid  about  a  quarter  of  an  inch 
behind  its  margin,  draw  the  lid  down  by  the  lashes  and  turn  it 
upward  and  outward  over  the  match  or  finger  tip.  If  the  particle 
is  still  not  visible  search  the  ball  of  the  eye  carefully  for  it,  and  when 
it  is  found  lift  it  off  gently  by  a  quick  movement  with  the  point  of 
the  match.  If  the  eye  is  very  irritable  it  may  be  necessary  to  drop 
in  a  little  cocaine  solution. 

It  is  important  to  remember  that  even  after  a  foreign  body  is  re- 

ni9) 


120  FIRST  AID 

moved  from  the  eye,  there  is  often  for  some  time  a  sensation  as  if 
it  were  still  there. 

In  the  ear:  The  foreign  body  here  may  be  an  insect,  a  pea,  or  grain 
of  wheat,  a  pebble,  a  plug  of  hardened  wax,  etc.  An  insect  in  the  ear 
by  its  movements  and  buzzing  often  causes  the  most  intense  annoy- 
ance. 

Hold  the  head  over  on  one  side  with  the  ear  containing  the  insect 
uppermost;  fill  the  ear  with  warm  water;  this  will  drown  the  insect 
in  a  few  minutes,  and  then  by  suddenly  turning  the  head  to  the  other 
side  it  may  come  out  with  the  water;  the  maneuver  should  be  re- 
peated several  times;  if  the  insect  does  not  come  away  syringe  the 
ear. 

If  the  foreign  body  is  vegetable,  such  as  a  pea,  water  should  not  be 
used  as  it  may  cause  the  pea  to  swell  and  thereby  render  its  extrac- 
tion more  difficult.  If  the  pea  is  visible  bend  the  loop  end  of  a  fine 
hairpin,  and  try  to  get  beyond  it  so  as  to  hook  it  out.  As  there  is 
always  danger  of  injuring  the  drum  when  instruments  are  pressed 
into  the  ear,  it  should  be  a  guiding  rule  that  no  instrument  should 
be  passed  beyond  the  point  where  its  tip  can  be  seen. 

Hardened  wax  must  be  removed  by  syringing  with  a  warm  five 
per  cent  solution  of  soda. 

In  the  nose:  Children  push  peas  and  such  things  into  the  nose,  and 
occasionally  flies  deposit  their  eggs  there  with  the  result  that  maggots 
develop  in  the  nasal  cavity.  Foreign  bodies  are  best  removed  by 
closing  the  free  nostril  with  the  finger  and  forcibly  blowing  through 
the  obstructed  side ;  snuffing  up  a  little  powdered  tobacco  or  pepper 
will  cause  sneezing  and  aid  in  the  expulsion ;  if  this  does  not  succeed 
and  the  body  can  be  seen  it  may  be  hooked  out  with  the  bent  hairpin 
in  the  same  manner  as  described  for  the  ear;  or  finally  a  small, 
smooth  stick  or  a  slender  pencil  may  be  wrapped  with  a  little  cotton 
and  used  to  push  the  foreign  body  gently  back  through  the  posterior 
nares  into  the  mouth ;  press  straight  backward,  never  upward. 

Maggots  in  the  nose  is  a  very  serious  condition  which  may  result 
in  death.  Let  the  patient  inhale  through  the  nose  a  half-teaspoonful 
of  chloroform,  and  while  the  maggots  are  stupefied  syringe  them  out 
with  warm  normal  saline  solution. 

Foreign  bodies  in  the  throat  are  usually  bones  or  masses  of  food. 
If  the  bone  can  be  seen  and  reached  it  may  be  removed  by  fingers  or 
forceps;  if  not,  it  may  be  carried  down  by  eating  dry  bread.     If  the 


FOREIGN  BODIES  121 

obstruction  is  a  mass  of  food  it  may  be  dislodged  by  forcible  blows 
on  the  back  between  the  shoulders,  or  the  fingers  may  be  passed  into 
the  throat  to  hook  it  out  or  to  cause  its  ejection  by  vomiting. 

Foreign  bodies  in  the  air  passages  cause  violent  cough  and  difficult 
breathing;  the  case  is  urgent,  and  if  a  child  he  may  be  held  up  by  his 
heels  and  shaken;  if  an  adult  inversion  may  also  be  attempted  and 
blows  between  the  shoulders  given  as  in  the  case  of  foreign  body  in 
the  throat. 

Foreign  bodies  are  sometimes  swallowed  and  reach  the  stomach 
and  intestines.  Such  cases  are  not  usually  serious.  If  the  body  is 
angular  or  pointed,  such  as  a  tack  or  a  pin,  feed  the  patient  on  sub- 
stances which  leave  considerable  residue  to  cover  and  protect  the 
sharp  points — potatoes,  bananas,  bread,  etc.  Do  not  give  laxatives 
as  they  will  render  the  movements  liquid  and  thus  leave  sharp  points 
exposed. 

In  the  skin:  Here  we  find  splinters,  thorns,  needles,  pins,  fish- 
hooks, pieces  of  glass,  gunpowder,  etc.  For  splinters  and  thorns  pass 
the  point  of  the  blade  of  a  pocket-knife  under  them,  with  the  thumb- 
nail press  the  splinter  against  the  blade  and  draw  it  out;  or  use  a 
pointed  dissecting  or  dressing  forceps.  If  the  splinter  is  buried  open 
up  the  skin  a  little  with  the  point  of  a  knife  or  a  needle  until  it  can  be 
reached.     If  under  a  nail,  make  a  notch  in  the  nail  so  as  to  expose  it. 

If  a  needle  or  pin  is  broken  ofif  in  the  skin  and  can  not  be  grasped 
with  forceps,  cut  a  small  hole  in  the  end  of  a  cork  and  press  it  down 
over  the  point  of  entrance  of  the  needle ;  this  may  cause  the  needle  to 
emerge  so  far  that  it  can  be  grasped.  The  needle  may  be  so  situated 
that  it  is  best  to  push  it  through  and  extract  it  on  the  other  side.  If 
the  needle  or  pin  is  in  the  foot  or  hand  and  can  not  be  extracted,  the 
patient  should  be  directed  not  to  use  the  part,  as  muscular  action  will 
cause  it  to  work  in  deeper.  A  fishhook  or  an  arrow  can  not  be 
drawn  out  on  account  of  the  barbs ;  they  must  be  pushed  through. 
Gunpowder  is  best  removed  by  a  thorough  scrubbing  with  soft  soap 
and  a  stiff  brush,  the  remaining  grains  being  picked  out  with  a 
needle. 


CHAPTER  VI 

THE  EFFECTS  OF  HEAT  AND  THE  EFFECTS  OF  COLD 

The  effects  of  heat  may  be  general  or  local.  Tht  general  effects 
of  heat  are  manifested  in  two  entirely  different  ways,  viz. :  heat 
stroke  and  heat  exhaustion. 

Heat  stroke,  sunstroke,  or  insolation  is  due  to  prolonged  exposure 
to  excessive  heat,  usually  the  heat  of  the  sun.  But  heat  stroke  may 
occur  in  hot  rooms,  and  in  the  stoking-rooms  of  steamships.  Ex- 
haustion and  improper  clothing  are  powerful  contributing  factors, 
hence  it  is  especially  apt  to  occur  to  soldiers  on  the  march. 

The  premonitory  symptoms  are  headache,  dizziness,  irritability, 
frequent  desire  to  urinate,  seeing  things  red  or  purplish;  with  or 
without  these  symptoms  the  patient  suddenly  falls  unconscious ;  the 
skin  is  dry  and  intensely  hot;  pupils  contracted;  pulse  full  and 
strong;  respirations  snoring;  there  may  be  convulsions;  if  the  tem- 
perature of  the  body  can  be  taken  it  will  usually  be  found  to  be  very 
high,  105°  F.  to  109°  F.  or  higher. 

The  condition  is  a  very  serious  one  and  unless  immediately  re- 
lieved terminates  in  death. 

The  treatment  has  for  its  object  rapid  reduction  of  the  tempera- 
ture. The  man  should  be  brought  to  the  coolest  accessible  spot,  in 
the  shade  if  out  of  doors,  on  deck  if  in  the  fire  room  of  a  steamer,  his 
clothing  removed  and  an  ice  bag  applied  to  his  head  and  cold  water 
poured  over  him  continually.  At  the  same  time  the  body  may  be 
rubbed  with  ice,  and  if  a  tub  is  available  he  may  be  immersed  in  cold 
water.  The  treatment  should  continue  until  the  temperature  is  re- 
duced. If  the  patient  is  able  to  swallow  he  should  be  given  cold, 
not  iced,  water  to  drink,  and  this  should  be  repeated  as  often  as 
possible. 

Serious  results  are  liable  to  follow  a  sunstroke,  even  when  death 
does  not  occur ;  the  most  common  of  these  after-effects  are  perma- 
nent headache,  paralysis,  mental  confusion,  or  even  insanity.  More- 
over, one  who  has  had  a  sunstroke  is  ever  after  very  susceptible  to 
the  action  of  the  sun. 

(122) 


EFFECTS  OF  HEAT  AND  EFFECTS  OF  COLD      123 

Heat  exhaustion  is  a  very  much  less  sever  condition,  closely 
allied  to  fainting.  It  occurs  among  soldiers  on  the  march  and  very 
frequently  among  soldiers  standing  for  some  time  at  attention  on  a 
hot  day.  The  soldier  suddenly  drops  his  piece  and  falls;  he  is  not 
unconscious  or  may  be  easily  aroused ;  face  is  pale,  skin  cool  and 
moist,  pupils  dilated  or  normal,  pulse  very  weak ;  respiration  shallow, 
perhaps  sighing. 

Such  a  patient  should  be  moved  into  the  shade,  his  clothing 
loosened,  equipments  removed,  head  kept  low,  and  a  drink  of  water 
or  some  stimulant  given.  On  removal  to  the  hospital  he  should  be 
kept  perfectly  quiet  in  bed  and  hot- water  bags  used  if  necessary. 

The  local  application  of  heat  produces  burns  or  scalds. 

Burns  are  produced  by  a  flame,  hot  solids,  or  caustics.  Scalds  are 
produced  by  hot  liquids ;  they  differ  only  in  that  in  the  former  the 
hairs  are  destroyed,  in  the  latter  they  are  not ;  the  treatment  is  the 
same. 

Burns  are  usually  said  to  be  of  the  first,  second,  or  third  degree. 
Burns  which  merely  cause  redness  are  of  the  first  degree;  if  blisters 
are  raised  they  are  of  the  second  degree;  and  if  there  are  charring 
and  destruction  of  tissue  the  burn  is  of  the  third  degree. 

The  symptoms  of  burn  are  shock  which  may  be  profound,  chilly 
sensations,  and  pain.     The  pain  may  be  agonizing  or  slight. 

The  result  of  the  burn  depends  more  upon  the  extent  of  surface 
affected  than  upon  its  depth,  a  burn  of  the  first  degree  is  almost  cer- 
tainly fatal  if  two-thirds  of  the  surface  of  the  body  is  affected,  and 
one  of  the  second  degree  if  one-third  of  the  body  is  burned;  the 
chances  for  recovery  are  much  less  in  children  and  elderly  people. 

The  danger  in  the  first  twenty-four  hours  is  from  shock;  after 
that  from  internal  congestions  and  inflammations,  suppression  of 
urine,  ulceration  of  the  duodenum,  and  intestinal  hemorrhage ;  and 
finally  from  exhaustion,  blood  poisoning,  or  tetanus. 

If  the  entire  thickness  of  the  skin  is  destroyed  terrible  deformities 
are  apt  to  follow  the  contraction  of  the  skin  which  occurs  in  healing. 

In  burns  of  the  first  degree,  of  which  sunburn  is  a  type,  soft  cloths 
dipped  in  a  saturated  solution  of  cooking  soda  should  be  applied, 
and  this  followed  by  any  fresh  oil  or  fat ;  cream  or  olive  oil  answers 
excellently  well. 

In  burns  of  the  second  and  third  degrees  the  objects  of  treatment 
are  first  protection  from  the  air  which  greatly  aggravates  the  pain 


124  FIRST  AID 

and  shock;  secondly  relief  of  shock,  and  third  prevention  of  infec- 
tion. 

The  quickest  temporary  means  of  excluding  air  is  to  immerse  the 
part  or  the  entire  body  in  warm  water;  then  having  gotten  every- 
thing ready  carefully  cut  away  the  clothing,  leaving  such  as  is  stick- 
ing to  the  burned  skin;  blisters  should  be  left  undisturbed  unless 
they  are  very  tense  and  painful,  when  they  may  be  punctured  by  a 
sterilized  needle  and  the  contents  allowed  to  escape. 

The  wound  should  next  be  dressed  with  sterile  gauze  dipped  in  a 
warm  solution  of  boric  acid,  or  a  solution  of  picric  acid  ten  parts  in 
eighty  parts  of  alcohol  and  a  thousand  parts  of  water ;  the  picric  acid 
relieves  the  pain  and  has  value  as  an  antiseptic ;  over  the  gauze  place 
a  thick  layer  of  sterile  absorbent  cotton.  When  the  burns  are  ex- 
tensive small  portions  only  should  be  exposed  and  dressed  at  a 
time.  When  the  first  dressing  is  finished  it  should  be  left  on  as 
long  as  possible. 

Meantime  stimulants  and  hot  drinks  should  be  given  internally 
and  morphine  and  strychnine  injected  hypodermically  if  necessary. 

When  there  has  been  skin  destruction  the  parts  should  be  re- 
tained in  proper  position  by  splints  when  healing  is  taking  place. 

In  burns  from  corrosive  acids,  such  as  sulphuric  and  nitric  acids, 
the  parts  should  be  thoroughly  flushed  with  water  and  a  solution  of 
soda,  after  which  tbe  treatment  is  the  same  as  for  other  burns. 

In  burns  from  caustic  alkalies,  such  as  lye,  vinegar  diluted  with 
water  should  be  used  to  neutralize  the  alkali  before  applying  the 
usual  treatment  for  ordinary  burns. 

When  the  clothing  of  a  person,  usually  a  woman,  is  on  fire  she 
should  be  enveloped  in  a  blanket,  rug,  cape,  or  woolen  coat  and 
thrown  upon  the  ground  while  the  flames  are  smothered ;  the  reason 
she  should  be  thrown  upon  the  ground  is  to  prevent  her  from 
running  about  and  thus  fanning  the  flames,  and  also  because  flames 
rise,  and  in  the  erect  position  would  reach  the  mouth  and  throat. 

The  effects  of  cold,  like  those  of  heat,  may  be  general  or  local. 

In  general  freezing  there  is  at  first  a  very  unpleasant  sensation  of 
cold  with  pain  in  the  extremities,  then  numbness  and  stiffness,  and 
finally  great  drowsiness  with  an  irresistible  desire  to  lie  down  and 
sleep,  which  if  yielded  to  is  soon  followed  by  death. 

When  one  is  found  in  such  a  condition,  life  not  yet  being  extinct, 
he  should  be  taken  into  a  cold  room,  all  clothing  removed,  and  the 


EFFECTS  OF  HEAT  AND  EFFECTS  OF  COLD   125 

body  rubbed  briskly  with  sheets  or  towels  wet  with  cold  water.  As 
soon  as  the  stiffness  is  removed  artificial  respiration  should  be  per- 
formed; and  when  the  patient  is  able  to  swallow,  warm  drinks 
should  be  given.  When  there  are  signs  of  returning  consciousness 
and  circulation  the  body  may  be  enveloped  in  a  blanket  and  the 
temperature  of  the  room  gradually  raised. 

The  reason  a  frozen  person  must  not  be  brought  into  a  warm  room 
is  that  the  sudden  restoration  of  the  circulation  gives  rise  to  violent 
congestions  and  often  to  sudden  death  from  the  formation  of  clots 
in  the  blood-vessels. 

Local  freezing  is  of  two  degrees,  frost-bite  and  chilblain. 

Frost-bite  is  usually  of  the  extremities,  fingers,  toes,  nose,  or  ears, 
but  a  whole  limb  may  be  frozen.  The  part  is  at  first  red  and  painful, 
then  livid,  and  finally  white,  hard,  and  painless ;  the  sudden  cessation 
of  pain  in  the  freezing  part  is  always  a  bad  sign.  The  danger  of 
frost-bite  is  that  sudden  thawing  may  cause  such  severe  congestion 
as  to  result  in  gangrene. 

Therefore  the  patient  should  not  go  mto  a  warm  room  or  near  a 
fire.  Rub  the  part  vigorously  with  wet  snow  or  ice  water,  never 
with  dry  snow  as  the  temperature  of  dry  snow  may  be  much  below 
freezing,  and  rubbing  with  it  would  aggravate  the  condition.  When 
the  pain  and  redness  return  apply  cold  dressings. 

Chilblain  is  a  condition  of  acute  or  chronic  congestion  occurring 
especially  in  the  feet,  and  due  to  bringing  cold  feet  near  the  fire  too 
suddenly,  or  merely  following  exposure  to  cold  in  persons  with 
poor  circulation.  On  the  part  affected  are  red  spots,  more  or  less 
swollen,  which  burn  and  itch  intensely.  The  treatment  consists  in 
stimulating  applications,  such  as  liniments  and  tincture  of  iodine. 
Susceptible  persons  should  wear  woolen  socks. 


CHAPTER  VII 

INSENSIBILITY   AND   FITS 

Among  conditions  causing  insensibility  are  fainting,  shock,  con- 
cussion and  compression  of  the  brain,  apoplexy,  lightning  stroke, 
electric  shock,  heat  stroke,  freezing,  epilepsy,  Bright's  disease,  alco- 
holism, narcotic  poisoning,  and  asphyxia  or  suffocation. 

Fainting  is  a  condition  due  to  too  little  blood  in  the  brain,  and 
is  caused  by  mental  impressions,  exhaustion,  heat,  bleeding,  over- 
crowded rooms,  etc.  The  symptoms  are  sudden  unconsciousness, 
pale  face,  cool,  moist  skin,  weak  pulse,  shallow  breathing,  and  dilated 
pupils. 

Treatment:  Get  more  blood  to  the  brain  by  laying  the  patient  fiat 
on  his  back  with  the  head  low  and  the  legs  raised;  sprinkle  cold 
water  in  his  face  and  apply  ammonia  or  smelling  salts  to  the  nostrils 
to  make  him  breathe,  get  him  out  of  a  crowd  into  the  fresh  air, 
loosen  the  clothing  about  his  neck  and  waist. 

If  he  is  sitting  in  a  chair  and  about  to  faint  the  attack  can  often  be 
prevented  by  thrusting  the  head  down  between  his  own  knees  and 
holding  it  there  until  the  face  becomes  flushed. 

Shock  is  a  condition  similar  to  fainting  but  due  to  physical  injury. 
It  has  been  fully  dealt  with  on  page  90. 

Concussion  of  the  brain  is  the  condition  present  when  we  say  a 
man  has  been  "  knocked  senseless  "  or  "  stunned."  It  is  a  jarring 
and  shaking  of  the  brain  due  to  blows  or  falls  upon  the  head  or  falls 
upon  the  feet;  the  brain  almost  stops  working  for  a  while.  The 
symptoms  are  unconsciousness,  pallor  of  the  face,  breathing  so  quiet 
and  shallow  that  it  can  hardly  be  detected,  pulse  fluttering,  pupils 
equal  and  usually  contracted. 

The  degree  of  insensibility  varies;  sometimes  the  patient  can  be 
aroused  but  is  irritable  and  lapses  again  into  unconsciousness  which 
may  last  minutes  or  hours.  Vomiting  and  turning  on  the  side  are 
favorable  symptoms. 

Treatment:  Perfect  rest  in  a  dark,  quiet  room;  warmth  externally 

(126;) 


INSENSIBILITY  AND  FITS  127 

if  the  surface  is  cold;  aromatic  spirits  of  ammonia  internally  or  by- 
inhalation  if  there  is  much  depression. 

Comptession  of  the  brain  is  as  its  name  implies  a  pressure  on  the 
brain.  This  pressure  is  due  usually  to  either  a  piece  of  bone  or  to 
blood  from  a  torn  vessel  which  has  escaped  inside  the  cranium  and 
as  it  can  not  get  out  must  compress  the  brain,  and  this  compression 
prevents  certain  parts  of  the  brain  from  working.  When  the  bleed- 
ing is  the  result  of  injury  the  condition  is  called  simply  compression 
of  the  brain ;  when  it  is  the  result  of  the  bursting  of  a  diseased  vessel 
without  any  violence  it  is  called  apoplexy;  the  result  and  the  symp- 
toms are  just  the  same. 

The  symptoms  of  compression  are  profound  unconsciousness; 
loud,  snoring  breathing ;  slow  pulse ;  pupils  usually  unequal  and  not 
reacting  to  light,  and  paralysis  on  one  side  of  the  body. 

If  the  compression  is  due  to  a  piece  of  broken  bone  the  symptoms 
come  on  immediately  after  the  injury,  while  if  it  is  due  to  bleeding 
they  may  come  on  later  and  gradually. 

Treatment :  If  the  compression  is  due  to  a  piece  of  depressed  bone 
the  bone  must  be  raised.  If  due  to  bleeding,  the  bleeding  must  be 
stopped;  surgical  relief  can  only  be  given  by  a  surgeon,  but  meantime 
keep  the  patient  quiet  with  his  head  slightly  raised ;  apply  an  ice  bag 
to  the  head,  give  him  a  hot  mustard  foot  bath,  and  put  a  few  drops 
of  croton  oil  in  a  teaspoonful  of  sweet  oil  on  his  tongue,  so  as  to 
send  the  blood  from  his  brain  to  the  feet  and  intestinal  tract. 

Lightning  stroke  may  cause  sudden  death,  insensibility,  or  severe 
burns.  If  the  patient  is  unconscious  but  living,  effort  should  be  made 
to  keep  him  alive;  perform  artificial  respiration  if  the  breathing 
fails;  give  stimulants  if  the  heart  is  weak,  and  apply  heat  externally 
if  the  surface  is  cold.     Burns  must  be  treated  like  other  burns. 

Electric  shock  is  caused  by  coming  in  contact  with  a  "  live  wire  " ; 
spasmodic  contraction  of  the  muscles  occurs  so  that  the  person  can 
not  let  go.  The  condition  and  results  are  exactly  like  lightning 
stroke. 

The  first  thing  to  be  done  is  to  rescue  the  patient  by  setting  him 
free  from  the  wire,  and  this  must  be  done  with  great  care,  as  to  touch 
him  with  the  bare  hands  will  cause  the  rescuer  to  get  the  same  shock. 

Immediately  break  the  circuit.  With  a  single  quick  motion,  free 
the  victim  from  the  current.  Use  any  dry  nonconductor  (clothing, 
rope,  board)  to  move  either  the  victim  or  the  wire.    Beware  of  using 


128  FIRST  AID 

metal  or  any  moist  material.  While  freeing  the  victim  from  the  live 
conductor  have  every  effort  also  made  to  shut  off  the  current  quickly. 

The  treatment  of  the  shock  is  the  same  as  in  the  case  of  lightning 
shock. 

The  forms  of  unconsciousness  due  to  heat  stroke  and  to  freezing 
have  already  been  described. 

Unconsciousness  from  acute  alcoholism  is  the  condition  known  as 
"  dead  drunk."  The  patient  is  insensible,  though  he  can  usually  be 
partially  aroused,  the  face  is  flushed  and  bloated,  eyes  bloodshot, 
pupils  usually  dilated,  skin  cold  and  clammy,  temperature  subnormal, 
respiration  snoring,  pulse  rapid  and  weak ;  there  is  no  paralysis. 

Treatment :  The  case  is  one  of  acute  poisoning  by  alcohol.  The 
.first  thing  to  be  done  is  to  empty  the  stomach,  by  tickling  the  throat 
or  by  giving  an  emetic  of  mustard  or  salt  and  warm  water.  Then 
sprinkle  cold  water  freely  upon  the  face,  but  apply  heat  to  the  body ; 
a  cup  of  hot  coffee  may  help  to  clear  the  brain  after  the  stomach  is 
emptied.     Usually  an  undisturbed  sleep  is  necessary. 

It  must  not  be  forgotten  that  alcoholism  and  apoplexy  are  fre- 
quently confounded,  the  more  so  as  a  man  who  has  been  drinking 
and  has  the  odor  of  liquor  upon  his  breath  may  be  stricken  with 
apoplexy. 

In  apoplexy  there  are  paralysis,  unequal  or  contracted  pupils, 
some  fever,  slow  pulse;  in  alcoholism  no  paralysis,  equally  dilated 
pupils,  rapid  pulse,  subnormal  temperature. 

In  epilepsy  there  may  be  fits  with  insensibility,  or  a  mere  momen- 
tary unconsciousness  with  slight  muscular  twitching,  but  in  which 
the  patient  does  not  fall. 

In  the  severe  form,  with  or  without  some  premonitory  sign,  the 
subject  suddenly  cries  out  in  a  peculiar  manner  and  falls  in  a  fit;  at 
first  the  entire  body  is  rigid,  then  there  are  general  convulsions  with 
jerking  of  the  limbs,  contortions  of  the  face,  and  foaming  at  the 
mouth;  after  a  few  minutes  the  convulsions  are  following  by  pro- 
found stupor,  and  this  generally  passes  off  in  deep  sleep.  During 
the  attack  the  eyeballs  may  be  touched  without  the  patient  flinching, 
the  pupils  are  dilated,  he  often  bites  his  tongue,  and  there  may  be 
involuntary  evacuations  of  the  bowels  and  bladder. 

Epileptic  stupor  may  be  distinguished  from  other  forms  of  un- 
consciousness by  the  history  of  the  fit,  and  of  other  fits,  by  the  foam 


INSENSIBILITY  AND  FITS  129 

at  the  mouth  and  the  bitten  tongue,  and  by  the  absence  of  any 
paralysis. 

Treatment:  You  can  do  nothing  to  stop  the  fit  or  to  control  it;  all 
that  can  be  accomplished  is  to  prevent  the  patient  from  hurting  him- 
self and  to  make  him  as  comfortable  as  possible;  do  not  attempt  to 
hold  him,  but  twist  a  handkerchief  and  passing  it  between  the  jaws 
tie  it  at  the  back  of  the  neck  to  keep  him  from  biting  his  tongue  until 
after  the  fit  is  over;  after  which  let  him  sleep  as  long  as  he  wishes. 

Epileptic  fits  are  frequently  feigned  by  soldiers  in  order  to  secure 
their  discharges.  The  feigned  attacks  usually  occur  at  night  when 
no  one  can  see  them ;  the  man  does  not  fall  so  as  to  hurt  himself,  does 
not  bite  his  tongue,  flinches  when  the  eyeball  is  touched ;  the  pupils 
are  not  dilated;  the  patient  can  be  aroused;  when  there  is  foaming 
at  the  mouth  a  piece  of  soap  will  often  be  found  inside. 

A  pail  of  cold  water  suddenly  thrown  upon  the  man's  head  and 
shoulders  usually  makes  the  diagnosis;  it  promptly  revives  the 
malingerer,  but  has  little  or  no  effect  upon  the  epileptic. 

The  insensibility  of  Bright's  disease  is  really  an  acute  poisoning 
from  the  retention  of  the  waste  products  which  the  diseased  kidneys 
are  not  able  to  carry  off.  The  unconsciousness  is  often  attended 
with  delirium  and  convulsions.  The  pupils  are  contracted,  the  pulse 
slow,  and  the  breathing  loud  and  snoring. 

The  distinguishing  characteristics  are  the  history  of  Bright's  dis- 
ease, the  waxy  color  of  the  skin,  sometimes  dropsy,  the  equally  con- 
tracted pupils,  the  absence  of  paralysis. 

Emergency  treatment :  Cold  cloths  to  the  head  and  a  hot  mustard 
poultice  to  the  back  over  the  kidneys. 

In  opium  poisoning  the  patient  may  be  very  sleepy  or  deeply  un- 
conscious, the  pupils  are  minutely  contracted,  the  respiration  very 
slow,  as  low  as  eight  or  ten  to  the  minute,  and  snoring,  and  the  pulse 
rapid  and  weak.  If  the  opium  has  been  swallowed,  empty  the  stom- 
ach by  an  emetic,  and  then  give  a  half  gramme  of  permanganate  of 
potash  dissolved  in  half  a  pint  of  water  to  destroy  what  opium  is  left. 
Next  keep  the  patient  awake  by  giving  him  strong,  black  coffee, 
pinching  him,  talking  to  him,  and  walking  him  up  and  down  if  pos- 
sible, but  not  to  the  point  of  exhaustion. 

Asphyxia  or  suffocation  is  another  cause  of  unconsciousness,  to 
which  it  is  necessary  to  devote  a  special  chapter. 
9 


CHAPTER  V 

ASPHYXIA 

Asphyxia  or  suffocation  is  that  form  of  unconsciousness  due  to  the 
cutting  off  of  the  supply  of  oxygen  to  the  lungs.  This  may  occur  in 
several  ways.  The  air  may  be  so  full  of  some  other  gas  that  the 
proper  amount  of  oxygen  cannot  reach  the  lungs;  this  is  what 
happens  in  cases  of  poisoning  from  illuminating  gas,  the  gases  in 
mines,  etc. 

When  a  person  is  buried  up  to  his  neck  in  a  slide  of  earth  or  snow 
he  may  be  asphyxiated  as  a  result  of  the  inability  to  expand  his  chest, 
even  though  the  mouth  and  nose  be  free.  The  air  may  be  cut  off  at 
the  mouth  as  when  one  is  smothered  by  a  pillow;  in  the  throat  by 
the  lodgment  of  food  in  the  larynx,  or  its  obstruction  with  the  mem- 
brane of  diphtheria.  The  supply  of  air  may  be  shut  off  by  the  pres- 
sure of  a  rope  or  fingers  when  one  is  hanged  or  strangled.  In 
drowning,  water  gets  ipto  the  air  passages  and  mechanically  shuts 
off  the  air.  Finally  when  anesthetics,  such  as  ether  or  chloroform, 
are  given,  asphyxia  may  result  from  an  insufficient  admixture  of  air. 

The  treatment  of  asphyxia  consists  first  in  removing  the  cause, 
second  in,  restoring  the  breathing  by  artificial  respiration.  If  the 
patient  is  overcome  by  gas  remove  him  to  the  fresh  air,  if  he  is  taking 
an  anesthetic  stop  it,  if  he  is  buried  in  a  snow-slide  dig  him  out  as 
quickly  as  possible,  if  there  is  a  piece  of  meat  in  the  throat  put  your 
finger  in  and  hook  it  out  or  beat  him  between  the  shoulders  and  jar 
it  out.  If  the  larynx  is  obstructed  by  membrane  it  may  be  necessary 
to  make  an  opening  into  the  trachea  (tracheotomy)  and  put  in  a 
tube ;  if  the  patient  is  hanging  cut  him  down ;  if  he  has  been  drowned 
get  the  water  out  of  his  air  passages,**  do  these  things  first,  then 
perform  the  artificial  respiration. 

Artificial  respiration  seeks  to  imitate  the  natural  breathing.  There 
are  several  methods,  the  following  recommended  by  the  "  Com- 
mittee on  Resuscitation  from  Electric  Shock,"  is  probably  the  best, 
as  it  can  be  done  with  the  least  difficulty  by  one  man. 

Proceeds    as    follows:     (a)   Lay  the  subject  on  his  belly,  with 

(130) 


ASPHYXIA 


131 


arms  extended  as  straightforward  as  possible  and  with  face  to  one 
side,  so  that  nose  and  mouth  are  free  for  breathing.  Let  an  assistant 
draw  forward  the  subject's  tongue. 


Fig.   75.— Artificial   Respiration.     Inspiration;   Pressure   GIT. 

(b)  Kneel  straddling  the  subject's  thighs  and  facing  his  head; 
rest  the  palms  of  your  hands  on  the  loins  (on  the  muscles  of  the 


Fic.  76. —  Artificial  Respiration.     Expiration;   Pressure  On. 

small  of  the  back),  with  fingers  spread  over  the  lowest  ribs,  as  in 

Fig-  75- 

(c)  With  arms  held  straight,  swing  forward  slowly  so  that  the 
weight  of  your  body  is  gradually,  but  not  violently,  brought  to  bear 


132 


FIRST  AID 


upon  the  subject  (see  Fig.  76).  This  act  should  take  from  two  to 
three  seconds. 

Immediately  swing  backward  so  as  to  remove  the  pressure,  thus 
returning  to  the  position  shown  in  Fig.  75. 

(d)  Repeat  deliberately  twelve  to  fifteen  times  a  minute  the 
swinging  forward  and  back  —  a  complete  respiration  in  four  or 
five  seconds. 


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Fig.  77. —  Artificial  Respiration.     Marshall  Hall's  method.     Expiration. 

(e)  As  soon  as  this  artificial  respiration  has  been  started,  and 
while  it  is  being  continued,  an  assistant  should  loosen  any  tight 
clothing  about  the  subject's  neck,  chest  or  waist. 

Continue  the  artificial  respiration  (if  necessary,  at  least  an  hour), 
without  interruption,  until  natural  breathing  is  restored,  or  until  a 
physician  arrives.  If  natural  breathing  stops  after  being  restored, 
use  artificial  respiration  again. 

Do  not  give  any  liquid  by  mouth  until  the  subject  is  fully  conscious. 

Give  the  subject  fresh  air,  but  keep  him  warm. 

Pause  for  a  moment  occasionally  to  see  whether  the  patient  makes 
any  effort  to  breathe;  if  he  does,  time  your  movements  so  as  to  cor- 


ASPHYXIA 


133 


respond  to  the  natural  inspiratory  and  expiratory  efforts.  Usually 
the  first  signs  of  success  are  a  change  in  the  color  of  the  face  and 
faint  sighing. 

Meanwhile  efforts  should  be  made  to  excite  respiration  in  other 
ways ;  apply  snuff,  tobacco,  pepper,  or  smelling  salts  to  the  nostrils, 
and  strike  the  chest  with  towels  dipped  in  hot  and  cold  water 
alternately. 

Marshall  Halls  method:  In  this  method  the  patient  is  placed  on 
the  floor  or  ground  with  the  face  downward,  his  forehead  resting  on 


Fig.  78. —  Artificial  Respiration.     Marshall  Hall's  method.     Inspiration. 

one  arm,  and  a  roll  of  clothing  supporting  his  chest.  While  in  this 
position  the  weight  of  the  body  compresses  the  ribs  and  expels  the  air 
from  the  chest  —  an  artificial  expiration  which  is  increased  by  mak- 
ing pressure  on  the  lower  ribs  (Fig.  yy).  Then  the  operator,  with 
one  hand  on  the  patient's  free  arm,  near  the  shoulder,  and  the  other 
placed  under  or  in  front  of  the  corresponding  hip  bone,  rolls  the 
body  from  face  downward  to  its  side  and  a  little  beyond  (Fig.  78). 
An  assistant  aids  in  this  movement  by  handling  the  head  and  under- 
lying arm.     When  the  body  has  been  thus  rolled  somewhat  more  than 


134 


FIRST  AID 


half  round,  the  chest  becomes  reUeved  from  superincumbent  weight, 
and  a  certain  volume  of  air  enters.  After  resting  a  second  or  two 
in  this  attitude  of  inspiration,  the  patient  is  returned  to  the  prone 
position,  and  pressure  made  along  the  ribs  to  imitate  the  expiratory 
act. 

Drowning:  There  are  wide  differences  of  opinion  as  to  how  long 
a  man  may  remain  under  water  after  drowning  and  yet  be  resusci- 
tated. It  is  probable  that  five  minutes  is  the  limit,  but  inasmuch  as 
no  record  is  usually  kept  of  the  time  and  it  may  be  actually  much 
less  than  what  it  appears  under  the  influence  of  excitement,  it  is  well 
to  make  an  effort  at  artificial  respiration  unless  the  time  is  actually 
known  to  have  been  greater  than  a  quarter  of  an  hour. 


Fig.  79.^  Getting  Water  Out  of  the  Lungs. 


To  clear  the  lungs  of  water  preliminary  to  artificial  respiration 
turn  the  patient  on  his  face  with  his  forehead  resting  on  his  wrist  and 
a  roll  of  clothing  under  his  chest ;  then  getting  astride  the  body  press 
on  the  back  to  force  out  the  water;  next  drop  your  hands  under  his 
abdomen  and  lift  up  his  body  with  the  head  hanging  down  so  that  the 
water  will  run  out  (Fig.  79). 

Besides  artificial  respiration  it  is  necessary  to  restore  the  heat  of 


ASPHYXIA  135 

the  body,  which  is  rapidly  lost  by  immersion  in  the  water,  and  to 
stimulate  the  circulation. 

While  efforts  at  artificial  respiration  are  going  on  remove  the  wet 
clothing,  wrap  the  body  in  dry,  hot  blankets,  apply  hot-water  bottles 
to  the  feet,  and  rub  the  limbs  actively  toward  the  heart,  stimulants 
should  be  given  hypodermically,  by  the  rectum,  and  by  the  mouth 
when  the  patient  can  swallow. 

When  respiration  is  established  put  the  patient  in  a  hot  bath  until 
the  body  heat  and  circulation  are  restored.  Even  when  artificial 
respiration  is  successful  after  drowning,  congestion  of  the  lungs, 
bronchitis,  or  pneumonia  is  apt  to  result  from  the  cold  and  the  irrita- 
tion of  the  lungs  by  the  water  which  has  gotten  into  them ;  to  prevent 
these  complications  large  mustard  plasters  should  be  applied  to  the 
chest. 


CHAPTER   IX 

POISONING 

Poisons  may  be  divided  into  two  classes,  those  which  are  takehi 
internally  or  hypodennically  and  those  which  are  applied  to  the  skin. 

Of  those  taken  internally  the  caustic  acids  and  alkalies  may  also 
be  applied  to  the  skin;  in  either  case  they  produce  burns.  When 
swallowed  the  burns  are  upon  the  lips,  in  the  mouth,  throat,  and 
stomach.  The  stains  are  seen  upon  the  lips,  and  the  symptoms  are 
intense  pain  and  agony,  and  vomiting  of  bloody  matter  mixed  with 
mucus  and  shreds  of  membrane.  The  treatment  consists  in  trying  to 
neutralize  the  poison,  protecting  the  burnt  surfaces  by  administering 
soothing  substances  such  as  oils,  milk,  white  of  eggs,  flour  and  water, 
etc.,  and  relief  of  pain  by  opiates. 

The  caustic  alkalies,  such  as  lye,  are  best  neutralized  by  vinegar  or 
lemon  juice  and  water,  and  the  caustic  acids,  such  as  sulphuric  and 
nitric,  by  magnesia,  cooking  or  washing  soda,  tooth  powder,  or  soap 
suds.  The  remainder  of  the  internal  poisons  may  be  divided  in  three 
general  classes : 

1.  Those  zvhose  principal  effect  is  upon  the  gastric-intestinal  canal, 
causing  violent  irritation  or  inflammation,  such  as  arsenic,  corrosive 
sublimate,  nitrate  of  silver,  oxalic  acid,  croton  oil,  and  sugar  of  lead. 

2.  Those  which  produce  little  or  no  local  irritation,  but  have  a 
pozverfid  general  effect,  especially  upon  the  nervous  system;  such  as 
opium,  chloral,  belladonna,  prussic  acid,  and  strychnine. 

3.  Those  which  are  both  local  and  general  poisons;  such  as  phenol, 
cantharides,  phosphorus,  and  aconite. 

In  the  treatment  of  cases  of  poisoning  our  first  object  is  to  empty 
the  stomach  and  prevent  the  absorption  of  any  poison  that  may  be 
left  in  it;  then  to  relieve  pain  and  obviate  the  tendency  to  death. 

An  emetic  is  ordinarily  used  to  empty  the  stomach,  and  those 
which  are  most  readily  available  are  warm  water,  mustard,  salt,  and 
ipecac ;  give  a  tablespoonful  of  mustard  or  salt  or  a  half-teaspoonful 
of  ipecac  dissolved  in  a  half-pint  of  tepid  water;  encourage  vomiting 

(136) 


POISONING  137 

by  running  the  fingers  down  the  throat  or  tickhng  it  with  a  feather; 
the  water  should  be  tepid  to  produce  nausea,  and  vomiting  should 
be  repeated  until  the  water  returns  clear.  If  a  stomach  tube  is 
available  the  stomach  should  be  washed  out. 

To  prevent  absorption  we  give  an  antidote,  that  is  something  that 
will  destroy  the  poison  or  its  effects,  usually  rendering  it  insoluble. 

Antidotes  are  general  and  special.  The  general  antidotes  are 
given  when  we  do  not  know  the  exact  nature  of  the  poison ;  thus  tan- 
nic acid  and  substances  such  as  tea  which  contain  it  are  antidotal  to 
the  poisonous  alkaloids  and  therefore  to  most  vegetable  poisons,  and 
albumin  and  substances  such  as  white  of  egg,  milk,  etc.,  which  con- 
tain it  are  antidotal  to  most  mineral  poisons.  The  special  antidotes 
should  be  used  when  we  know  the  exact  nature  of  the  poison; 
hydrated  magnesia  or  hydrated  oxide  of  iron  is  the  special  antidote 
to  arsenic,  salt  to  the  nitrate  of  silver,  chalk  or  tooth  powder  to 
oxalic  acid,  soluble  sulphates  such  as  Epsom  or  Glauber's  salts  k> 
phenol  and  sugar  of  lead,  sulphate  of  copper  to  phosphorus,  and 
permanganate  of  potash  to  opium. 

The  antidote  is  given  at  the  same  time  as  or  immediately  after  the 
emetic. 

The  relief  of  suffering  calls  for  soothing,  bland  liquids,  such  as 
olive  oil  or  milk  when  there  is  burning  pain  in  the  stomach  and 
bowels,  and  also  for  morphine  hypodermically. 

To  obviate  the  tendency  to  death  observe  in  what  way  life  is  threat- 
ened and  endeavor  to  counteract  that  effect.  If  there  is  shock  and 
collapse,  use  stimulants,  warmth,  and  rubbing;  if  the  heart  is  failing 
as  in  poisoning  by  aconite,  chloral,  or  prussic  acid  stimulate  it  by  hot 
coffee,  strychnine,  digitalis,  etc. ;  if  there  is  failure  of  respiration  as 
in  phenol  poisoning  use  coffee,  cold  douching,  and  artificial  respira- 
tion ;  if  there  are  violent  convulsions  as  in  strychnine  poisoning  use 
bromides,  chloral,  or  chloroform;  if  there  is  tendency  to  sleep  keep 
the  patient  awake  by  the  administration  of  coffee,  slapping  the  face 
and  chest  with  a  wet  towel,  and  walking  him  about. 

To  sum  up :  if  you  do  not  know  zvhat  the  poison  is,  but  there  are  ~ 
signs  of  burning  or  caustic  action  about  the  mouth  and  lips,  do  not 
give  an  emetic,  give  a  tablespoonful  of  bland  oil,  such  as  olive  oil  or 
cottonseed  oil,  or  castor  or  cod-liver  oil ;  get  the  patient  to  bed,  relieve 
his  pain,  put  mustard  plaster  over  the  stomach,  and  try  to  keep  him 
alive.     You  do  not  give  an  emetic  in  such  cases  because  the  burned 


138  FIRST  AID 

stomach  might  give  way  in  vomiting,  and  the  caustic  would  burn  as 
much  coming  up  as  it  did  going  down. 

If  you  do  not  know  what  the  poison  is,  but  the  lips  and  mouth  are 
not  burned,  give  an  emetic  followed  by  two  or  three  raw  eggs,  a  glass 
of  milk,  or  flour  and  water,  and  then  a  cup  of  strong,  hot  tea,  after 
which  relieve  pain  and  obviate  the  tendency  to  death. 

When  you  do  know  the  poison  give  the  emetic,  and  the  antidote ; 
then  relieve  pain  and  keep  the  patient  alive. 

Among  the  substances  which  most  commonly  cause  poisoning  are 
phenol,  opium,  wood  alcohol,  foods,  chloral,  arsenic,  corrosive  sub- 
limate, nitrate  of  silver,  phosphorus,  and  strychnine. 

Phenol  is  usually  taken  in  concentrated  form,  and  may  produce 
death  in  an  hour  or  two.  The  symptoms  are  white  patches  on  the 
lips,  burning  pain  in  the  stomach,  intense  depression,  cold,  clammy 
skin,  weak  pulse,  failing  respiration,  stupor,  and  death.  The  anti- 
dotes are  the  soluble  sulphates  and  albumen,  but  they  cannot  be 
depended  upon.  Give  emetics,  then  wash  out  the  stomach  thoroughly 
with  water  containing  about  two  ounces  of  Epsom  or  Glauber's  salts, 
then  give  two  raw  eggs  or  a  pint  of  milk.  Perform  artificial  respira- 
tion and  use  stimulants,  heat  and  rubbing. 

When  phenol  is  dropped  on  the  skin,  alcohol,  if  used  promptly, 
will  completely  prevent  any  burning. 

Opium. —  The  treatment  of  opium  poisoning  has  been  described 
on  page  129. 

Wood  alcohol  or  methyl  alcohol  is  a  very  dangerous  poison  used  as 
a  fuel,  and  in  the  manufacture  of  toilet  preparations  such  as  bay  rum. 
The  symptoms  of  poisoning  by  it  are  severe  pains  in  the  head  and 
abdomen,  dizziness,  vomiting,  delirium,  partial  or  complete  blindness, 
dilated  pupils,  great  depression  of  the  heart  and  respiration,  some- 
times albuminuria,  stupor,  and  death.  If  the  patient  recovers  he  is 
often  left  blind. 

The  treatment  consists  in  use  of  emetics,  or  washing  out  the 
stomach,  emptying  the  bowels  by  cathartics  and  enema,  active  stimu- 
lation by  whisky  and  cofifee  internally  and  strychnine  hypodermically, 
artificial  respiration  if  necessary,  and  external  warmth. 

Ptomaine  poisoning  is  usually  due  to  the  use  of  foods  which  have 
undergone  partial  decomposition,  though  there  may  be  no  change  in 
their  taste  or  odor.  The  poisonous  decomposition  is  especially  apt  to 
occur  in  hashes,  milk,  or  foods  containing  milk  which  have  been  kept 


POISONING  139 

over  night  in  warm  weather.  Sausage,  cheese,  and  shell-fish  some- 
times undergo  the  same  changes.  Many  cases  of  poisoning  of  this 
kind  have  occurred  at  military  posts;  sometimes  whole  companies 
have  been  poisoned  at  the  same  time. 

The  symptoms  are  much  like  those  of  wood-alcohol  poisoning,  only 
vision  is  not  usually  affected  and  there  may  be  some  fever  and  some 
purging. 

In  treatment  the  first  thing  to  do  is  to  empty  the  stomach  and 
bowels  of  the  poison  by  the  use  of  emetics  and  active  cathartics. 
Then  relieve  pain  and  give  stimulants  with  heat  externally  and 
mustard  plasters  over  the  abdomen. 

Chloral  is  the  drug  usually  employed  to  make  "  knockout  drops." 
It  causes  deep  sleep  followed  by  insensibility,  with  failure  of  the 
heart  and  stometimes  the  respiration.  Empty  the  stomach  and  keep 
the  patient  awake  by  the  same  means  as  in  opium  poisoning,  except 
that  on  account  of  his  weak  heart  the  patient  must  not  be  made  to 
walk  about  as  in  opium  poisoning,  and  for  the  same  reason  strychnine 
must  be  freely  used  hypodermically. 

/w  arsenic  poisoning  there  is  great  pain  in  the  abdomen,  with  vomit- 
ing and  .purging,  tenderness,  straining  and  perhaps  suppression  of 
urine,  severe  depression  and  anxiety,  weak,  rapid  pulse,  and  cold, 
clammy  skin.  Use  emetics  or  the  lavage  tube,  give  a  tablespoonful 
of  freshly  prepared  hydrated  oxide  of  iron  every  ten  minutes  for 
five  or  six  doses.  The  hydrated  oxide  is  prepared  by  precipitating 
the  tincture  of  the  chloride  of  iron  with  aqua  ammonia,  and  wash- 
ing the  precipitate  to  remove  the  excess  of  ammonia.  Then  give 
morphine,  stimulants,  and  soothing  drinks,  with  external  heat  and 
friction. 

Corrosive  sublimate  may  be  swallowed  by  mistake  in  the  form  of 
an  antiseptic  solution.  The  symptoms  are  about  the  same  as  in 
arsenic  poisoning  and  the  treatment  is  much  the  same  except  that 
the  antidote  is  albumen  instead  of  hydrated  oxide  of  iron,  and  that 
the  antidotal  eflfect  is  only  temporary  so  that  emetics  must  be  used 
after  the*  antidote. 

Nitrate  of  silver  may  be  swallowed  accidentally  as  when  a  piece  of 
lunar  caustic  breaks  oflF  and  drops  down  the  throat.  Common  table 
salt  dissolved  in  water  should  be  given  freely ;  it  is  at  once  a  special 
antidote  and  an  emetic. 

Phosphorus  is  sometimes  taken  in  the  form  of  match-heads.     It 


140  FIRST  AID 

is  an  irritant  poison  like  arsenic  and  corrosive  sublimate.  Sulphate 
of  copper  is  the  antidote  and  also  an  emetic ;  it  should  be  given  one- 
fifth  of  a  gram  every  five  or  ten  minutes  with  tepid  water. 

Phosphorus  is  the  one  irritant  mineral  poison  for  which  oils  should 
not  be  given  because  its  absorption  is  favored  by  them. 

Strychnine  causes  violent  convulsions  with  intervals  of  rest;  there 
are  also  pains  and  cramps  in  the  abdomen.  Death  is  the  result  of 
asphyxia  in  the  convulsions  or  exhaustion  following  them.  Use 
emetics  or  the  lavage  tube,  bromides  and  chloral,  chloroform. 

Substances  zvhich  produce  poisoning  when  applied  to  the  skin  are 
chiefly  plants  of  the  rhus  family  such  as  "  poison  oak,"  "  poison  ivy," 
and  "  poison  sumac."  Other  plants  such  as  the  common  garden 
parsnip  produce  poisoning  occasionally. 

Some  persons  are  not  susceptible  while  other  persons  are  so  much 
so  that  they  appear  to  be  poisoned  even  without  actual  contact. 
"  Poison  oak  "  is  a  stubby  plant  with  three  leaflets  notched  on  the 
edge  and  downy  on  the  under  surface ;  "  poison  ivy  "  climbs  on  rocks 
and  trees ;  it  is  distinguished  from  "  Virginia  creeper,"  which  it 
resembles,  by  having  three  leaflets  instead  of  five  and  by  having  a 
hairy  trunk  and  little  clusters  of  white  berries ;  "  poison  sumac  "  is 
distinguished  from  the  harmless  variety  by  having  white  berries 
instead  of  red.  The  symptoms  of  rhus  poisoning  are  an  inflamma- 
tion "of  the  skin  closely  resembling  erysipelas,  redness,  swelling, 
burning  and  itching,  sometimes  vesicles ;  it  is  especially  apt  to  occur 
on  exposed  parts  such  as  the  face  and  hands. 

The  treatment  consists  in  dissolving  off  any  remaining  poison  with 
alcohol  and  then  applying  alkaline  lotions,  such  as  a  saturated  solu- 
tion of  bicarbonate  of  soda. 


PART  IV 

NURSING 

Nursing  in  post  and  field  hospitals  is  ordinarily  done  by  mem- 
bers of  the  hospital  corps.  In  general  hospitals,  base  hospitals,  and 
other  fixed  hospitals  of  active  service  it  is  done  by  the  nurse  corps 
(female)  and  the  hospital  corps. 

The  conditions  most  essential  to  the  recovery  of  the  sick  are  rest, 
absolute  cleanliness,  and  an  abundance  of  fresh  air,  and  these  the 
nurse  should  always  seek  to  secure.  Not  all  hospital  corps  men  are 
fit  to  become  nurses,  but  all  must  receive  training  in  this  subject  in 
order  to  show  whether  or  not  they  possess  the  aptitude.  Study  and 
experience  are  both  necessary  and  the  two  must  go  together. 


CHAPTER    I 

THE   WARD 

The  wards  of  all  post  hospitals  are  arranged  on  the  same  general 
plan. 

The  number  of  beds  in  each  ward  varies  from  twelve  to  eighteen 
and  usually  there  is  connected  with  each  a  toilet-room  with  baths, 
basins  and  water-closets,  and  a  wardmaster's  room.  Near  the  ward 
is  a  room  or  cabinet  for  patients'  eflfects,  and  a  linen  closet  sufficient 
to  contain  enough  linen  for  current  ward  use. 

The  beds  are  arranged  in  pairs  between  adjacent  windows,  with 
a  space  of  thi:ee  feet  between  the  beds  and  three  and  a  half  feet 
between  each  pair  of  beds.  About  lOO  feet  of  floor  space  and  1,200 
cubic  feet  of  air  space  are  allowed  to  each  bed ;  in  the  tropics  this 
should  be  increased  to  about  150  square  feet  floor  space  and  3,000 
cubic  feet  of  air  space ;  in  wards  for  infectious  diseases  the  floor 
space  should  be  the  same  as  that  allowed  for  the  tropics. 

(141) 


142 


NURSING 


Between  each  pair  of  beds  is  a  chair,  and  adjoining  each  bed  a 
glass  and  iron  bedside  table;  this  with  a  folding  bed-screen  con- 
stitutes the  official  furniture  of  the  ward  which  is  purposely  made 
as  free  as  possible  from  appliances  which  are  not  only  useless  but 
collecting  places  for  dirt  and  disease  germs.  Usually,  however, 
there  is  a  table  for  the  wardmaster  or  nurse,  and  an- 
other with  a  small  cabinet  to  contain  ward  medicines. 
Field  hospitals,  which  have  an  ordinary  capacity  of 
216  beds,  are  for  temporary  use  only,  to  supply  shelter, 
food,  and  emergency  treatment  and  are,  therefore,  not 
supplied  with  cots  or  furniture ;  the  patients  are  placed 
on  straw,  covered  by  blankets. 

The  post  hospital  ward  is  heated  by  hot  water  or 
steam  and  ventilated  by  special  openings  for  entrance 
and  exit  of  air.  These  air  shafts  are  calculated  to 
introduce  three  thousand  six  hundred  cubic  feet  of 
fresh  air  per  hour  per  patient.  The  entering  air  is 
warmed  by  passing  over  hot-water  coils  beneath  the 
floor,  while  foul  air  escapes  through  shafts  artificially 
Fig.  80.— Win-   heated  by  hot- water  pipes  so  as  to  produce  an  up 

dow  Ventilation;  "^  ^  ^  ^ 

board  below  low-    draught, 
er  sash. 

When  no  special  arrangements  are  made  for  ventila- 
tion the  natural  openings  of  the  ward,  such  as  doors  and  windows, 
are  used  for  the  purpose.     The  object  must  be  to  introduce  as  much 
fresh  air  as  possible  without  reducing  the  tem- 
perature of  the  ward  below  the  normal  standard 
of  68°  to  70°  F.,  and  without  causing  unpleasant 
draughts. 

One  of  the  simplest  plans  to  secure  ventilation 
when  this  is  not  specially  provided  for  is  to  place 
a  board  under  the  raised  lower  sash,  the  air  pass- 
ing in  between  the  sashes  (Fig.  80),  or  to  pull 
down  the  upper  sash  and  protect  the  opening  by  p,c  gi.— Window 
a  sloping  board  ( Fig.  81 ) .  In  either  case  the  cold  STvI'^ash.'  ^  °  ^ '  '^ 
entering  air  is  directed  upward.  Occasionally 
it  is  necessary  to  flush  out  the  ward  by  opening  wide  the  doors  and 
windows  for  a  few  minutes;  in  such  cases  the  patients  should  be 
thoroughly  wrapped  up  as  if  out  of  doors. 

Each  ward  is  under  the  care  of  a  noncommissioned  officer  or 


^ 


/->!  \ 


ir^a 


t 


T^ 


THE  WARD  143 

private  first  class  assigned  as  wardmaster,  who  is  responsible  for 
the  comfort,  diet,  and  medication  of  the  patients,  the  performance 
of  their  duty  by  the  nurses,  the  preservation  of  the  ward  property, 
the  regulation  of  the  heat,  lights,  and  ventilation,  and  the  cleanliness 
of  the  bed  linen  and  clothing,  lavatories,  baths,  water  closets,  etc. 
One  nurse  is  sufficient  for  a  ward  of  twenty  beds  when  the  cases  are 
not  of  an  acute  character,  but  two  may  be  required  under  special 
conditions. 

The  wardmaster  or  nurse  accompanies  the  medical  officer  on  his 
rounds,  takes  down  his  directions  in  the  ward  book,  and  sees  that 
they  are  carried  out.  Each  nurse  has  specified  duties  assigned  to 
him,  so  that  each  may  know  exactly  what  is  expected  of  him.  He 
should  from  the  first  cultivate  habits  of  observation,  neatness,  and 
system.  Each  time  he  passes  about  his  ward  he  should  observe  the 
condition  of  his  patients,  the  beds,  chairs,  tables,  etc.,  and  should  at 
once  correct  anything  that  is  out  of  order.  There  should  be  a  place 
for  everything  and  everything  in  its  place.  When  anything  has  been 
used  it  should  at  once  be  cleaned  and  put  back  where  it  belongs,  so 
that  when  occasion  for  its  use  comes  again  no  time  may  be  lost  in 
looking  for  it  and  cleaning  it. 

When  a  medical  officer  unattended  by  a  noncommissioned  officer 
enters  the  ward  the  wardmaster  should  at  once  arise  and  call  atten- 
tion and  at  the  same  time  approach  the  medical  officer  to  render  any 
assistance  he  may  require;  the  same  courtesy  must  be  rendered  the 
commanding  officer  of  the  post  or  other  authorized  inspector. 
•  When  strangers  enter  the  ward  he  should  ascertain  their  business 
and  show  them  proper  courtesies;  they  should  not  be  allowed  to 
wander  through  the  ward  by  themselves. 

A  wardmaster  should  never  leave  his  ward  without  informing  his 
senior  nurse  where  he  is  going  and  for  how  long  and  placing  the 
latter  formally  in  charge. 

The  tour  of  a  night  nurse's  duty  usually  extends  from  immediately 
after  dinner  until  after  breakfast  the  following  morning.  The  day 
nurses  serve  the  dinner  to  the  patients  and  the  night  nurses  the 
breakfast;  each  completes  his  own  work  and  cleans  up  everything 
that  has  been  used  by  him  during  his  tour  of  service.  The  night 
nurse  renders  a  written  report  of  all  that  has  happened  during  the 
night  and  turns  over  to  the  day  nurse  any  instructions  he  may  have 
received. 


144  NURSING 

In  each  ward  a  book  should  be  kept  containing  a  complete  inven- 
tory of  all  the  ward  furniture,  bedding,  and  appliances;  when  any 
of  these  articles  become  soiled,  worn  out,  or  broken  they  are  ex- 
changed for  clean  or  new  ones,  but  the  number  of  each  should  as 
far  as  possible  be  maintained  unchanged. 

When  a  wardmaster  is  relieved  in  a  ward  he  should  turn  over  the 
articles  to  his  successor  and  take  his  receipt  in  the  book. 

Going  on  duty  in  the  morning  the  nurse  must  begin  at  once  to 
get  things  in  order  for  the  morning  rounds,  usually  at  nine  o'clock. 
Chairs  should  be  put  in  their  places,  bedside  tables  cleared  of  super- 
fluous articles,  and  beds  made  up.  Bed  patients  should  have  their 
hands,  faces,  and  teeth  washed,  and  hair  brushed.  Convalescents 
who  are  able  to  do  so  may  be  required  to  assist  in  the  ward  work. 

The  floors  should  be  dusted  with  a  floor  brush  covered  with  a  cloth 
wrung  out  of  five  per  cent  phenol  solution  and  quickly  polished 
with  the  polishing  brush,  and  if  of  tile  scrubbed  with  soap  and  water 
as  often  as  necessary,  and  the  chairs,  tables,  beds,  and  windowsills 
freed  from  dust  by  a  cloth  dampened  in  the  same  solution. 

Hospital  floors  should  be  made  as  impervious  as  possible,  so  that 
they  may  not  absorb  germs  and  dirt.  They  ordinarily  have  a  hard 
finish  and  are  kept  smooth  and  polished  by  using  on  them  a  solution 
of  paraflin  or  paraffin  and  wax  in  turpentine,  and  frequent  polishing 
with  a  weighted  polishing  brush  covered  with  a  piece  of  blanket. 
A  commonly  used  preparation  consists  of  six  ounces  of  paraflin 
dissolved  in  a  gallon  of  turpentine,  with  the  addition  of  an  ounce  of 
soft  soap  just  before  using;  this  is  applied  with  a  mop,  and  when 
dry  is  rubbed  in  with  the  floor  polisher. 

A  floor  so  finished  should  not  be  scrubbed  with  water ;  spots  may 
be  removed  with  turpentine. 

After  the  ward  is  made  ready  the  lavatory  should  be  attended  to; 
all  urinals,  bed  pans,  and  bottles  should  be  thoroughly  cleaned, 
shelves  wiped  off,  closet-bowls  and  seats  washed,  and  bath  tubs 
scrubbed. 

To  clean  brass,  copper  and  nickel,  a  mixture  of  oxalic  acid, 
alcohol  and  kerosense  is  very  eflfective ;  for  enameled  ware  use  soap 
and  hot  water,  removing  stains  with  chlorinated  lime. 

For  porcelain  utensils  never  use  sapolio,  oxalic  acid  or  strong 
alkalies;  they  destroy  the  enamel;  warm  water  and  soap,  followed 
by  kerosene,  are  best. 


THE  WARD  145 

In  addition  to  this  daily  cleaning  a  more  thorough  preparation  is 
made  for  Saturday  inspection.  The  walls,  window  borders,  and  all 
projections  and  corners,  should  be  brushed  with  a  soft  long-handled 
brush  covered  with  a  damp  cloth.  Windows  and  sills,  tables,  chairs, 
and  unoccupied  beds  are  washed,  and  cots  and  mattresses  gone  over 
for  bed-bugs. 

To  destroy  bed-bugs  a  saturated  solution  of  phenol,  or  kerosene 
oil  is  usually  employed,  the  solution  or  kerosene  being  freely  applied 
in  all  cracks  and  crevices  and  along  the  seams  of  mattresses.  Hy- 
drocyanic acid  gas  is  very  useful  for  the  destruction  of  bed-bugs, 
flies,  cockroaches,  and  other  vermin  which  may  infest  hospitals. 
The  gas  is  generated  from  cyanide  of  potash  by  the  addition  of  com- 
mercial sulphuric  acid.  An  ounce  each  of  cyanide  of  potash  and 
sulphuric  acid  and  two  ounces  of  water  are  required  for  each  hun- 
dred cubic  feet  of  air  space,  and  the  apartment  must  be  tightly  closed 
for  six  to  eight  hours  in  the  same  manner  as  in  fumigation  with 
sulphur  or  pyrethrum.  The  objection  of  cyanide  fumigation  is  the 
great  danger  to  human  life  from  breathing  the  fumes  of  the  gas, 
which  precludes  its  employment  in  any  part  of  an  occupied  house,  or 
in  a  house  in  a  block  separated  from  other  houses  by  party  walls  only. 

Beds  and  mattresses,  however,  may  be  freed  from  insects  by 
fumigating  them  in  a  tightly  constructed  chamber  or  box  such  as  is 
used  for  disinfecting  objects  with  formaldehyde  gas.  The  room 
having  been  made  ready,  the  proper  amount  of  sulphuric  acid  and 
water  is  placed  in  a  porcelain  basin  or  slop  jar  to  which  is  quickly 
added  a  thin  paper  bag  containing  the  corresponding  quantity  of 
cyanide  of  potash ;  the  operator  then  immediately  leaves  the  room 
and  closes  the  door.  After  six  to  eight  hours  the  door  is  thrown 
open  for  the  escape  of  the  gas  and  the  entrance  of  fresh  air,  and  on 
no  account  must  any  one  enter  the  room  until  the  odor  of  the  gas 
has  practically  disappeared. 

It  must  never  be  forgotten  that  this  gas  is  absolutely  deadly  to 
human  life,  and  that  even  a  mementary  exposure  to  it  may  be  fatal. 

Whenever  a  bed  is  vacated  mattress  and  bedding  should  be  thor- 
oughly aired  and  sunned,  and  disinfected  if  necessary.  The  same 
bed  linen  should  never  be  used,  without  washing,  for  two  consecutive 
patients. 

In  addition  to  the  daily  and  weekly  cleaning  there  should  be  a 
10 


146  NURSING 

thorough  disinfection  of  the  wards  twice  a  year  or  whenever 
infected. 

To  prevent  the  pollution  of  the  ward  air,  all  discharges,  such  as 
urine,  feces,  sputum,  and  vomited  matter,  soiled  dressings  and  linen, 
and  dirty  vessels  should  be  promptly  removed.  The  vessel  con- 
taining discharges  should  be  covered  at  once,  using  a  piece  of  rubber 
sheeting  or  a  towel  if  the  vessel  has  no  cover,  and  should  never  be 
carried  through  the  ward  uncovered. 

Soiled  dressings  should  be  received  in  a  covered  pail  or  paper  bag 
and  promptly  burned. 

Sputum  cups  in  use  should  be  frequently  disinfected  by  boiling, 
and  bed  pans  iand  urinals  scalded  with  hot  water  after  each  use  and 
always  kept  clean. 


CHAPTER    II 

WARD    MANAGEMENT 

A  PATIENT  may  be  able  to  walk  to  the  hospital  or  he  may  be 
brought  there  in  an  ambulance  or  on  a  litter.  In  either  case  he 
should  be  examined  at  once  by  the  senior  noncommissioned  officer 
present;  if  he  has  been  seen  already  by  a  medical  officer  direction 
for  his  dosposition  should  accompany  him;  if  he  has  not  been  seen 
by  a  medical  officer  one  should  be  notified  promptly.  Pending  his 
arrival  the  noncommissioned  officer  should  take  the  necessary  steps, 
taking  care  that  no  contagious  case  goes  into  the  general  wards. 
Generally  there  is  a  standing  rule  in  hospitals  that  all  patients  should 
be  given  a  bath  before  being  put  to  bed  unless  there  are  orders  to 
the  contrary  or  the  patient's  condition  is  such  as  to  render  a  bath 
undesirable.  After  the  bath  the  patient  is  given  a  suit  of  hospital 
clothing  and  put  to  bed.  An  inventory  of  his  effects  is  made  in 
duplicate  and  signed  by  the  wardmaster,  one  copy  in  a  book  and  the 
other  on  a  name  slip  which  is  attached  to  the  bundle.^  Take  every- 
thing out  of  the  patient's  pockets  and  place  all  valuables  such  as 
money,  watches,  jewelry,  etc.,  in  a  separate  package,  on  which  should 
be  written  the  name  of  the  patient,  number  of  the  room  and  of  the 
ward,  the  date,  and  a  list  of  the  effects;  the  package  should  be  at 
once  sent  to  the  office  for  safekeeping.  The  clothing  is  then  in- 
spected and  if  it  requires  disinfection  is  at  once  sent  to  the  disin- 
fecting chamber;  otherwise  the  underclothing  should  go  to  the 
laundry  and  the  remainder,  tied  securely  in  a  bundle,  to  the  locker 
corresponding  to  the  patient's  bed.  Valuables  should  be  listed, 
placed  in  en  envelope  marked  with  the  name,  date,  and  contents, 
and  at  once  turned  over  to  the  senior  noncommissioned  officer  for 
deposit  in  the  hospital  safe.  Meantime  it  is  well  to  offer  the  patient 
a  glass  of  water  or  milk  to  make  him  feel  that  he  is  being  cared  for. 
After  the  patient  is  comfortably  in  bed,  his  pulse,  temperature,  and 
respiration  are  taken  and  recorded;  the  first  urine  passed  is  saved 
in  a  clean  vessel  for  examination. 


1  In  the  larger  hospitals  a  property  card  is  filled  out  by  the  wardmaster,  and,  together 
with  one  of  duplicate  tags,  numbered  serially,  attached  to  the  property;  the  other  tag  it 
given  to  the  patient. 

(147) 


148 


NURSING 


Fig.   82.— Bed  Tray. 


Bed  patients  should  wear  hospital  clothing  only ;  but,  on  the  other 
hand,  patients  allowed  up  should  not  be  permitted  to  wear  hospital 
gowns  or  pajamas  under  their  own  clothes;  unless  this  point  is 
looked  to,  hospital  clothing  will  often  be  missing. 

Food  and  medicines  must  be  administered  promptly  and  in  a 
proper  way. 

The  nurses'  hands  must  be 
kept  clean  and  free  from 
odors.  Nothing  is  more  dis- 
gusting to  one  who  is  already 
ill  than  to  have  food  pre- 
sented with  dirty  hands. 

One  of  the  most  important 
duties  about  the  hospital  and 
perhaps  the  one  most  fre- 
quently neglected  is  the  serving  of  diets.  The  noncommissioned 
officer  in  charge  of  the  mess  is  responsible  under  the  senior 
noncommissioned  officer  and  should  be  in  the  wards  at  meal 
times  to  see  personally  that  fhe  diets  are  promptly  and  properly 
served.  Utensils  should  be  clean,  plates  warmed,  and  no  slopping 
over  allowed.  Food  which  is  intended  to  be  hot  should  reach  the 
patient  in  that  condition.  Used  utensils  and  unconsumed  food 
should  be  promptly  removed  from  the  ward  and  all  crumbs  and 
debris  cleaned  up. 

Patients  able  to  sit  up  in  bed  use  the  bed  tray  (Fig.  82),  those 
unable  to  sit  up  must  be  fed  by  the  nurse.     To  administer  liquids  the 

head  and  shoulders  are  raised  and  a 
feeding  cup  (Fig.  83)  or  an  ordinary 
cup  or  tumbler  is  used.  When  the 
head  should  not  be  raised  the  liquid 
may  be  taken  through  a  bent  glass 
tube.  When  the  sick  man  is  uncon- 
scious, liquids  must  be  given  very 
slowly,  taking  care  to  avoid  choking. 

Utensils  used  for  patients  with  infectious  diseases  must  be  kept 
separate  from  others  and  separately  washed.  Especially  is  this  im- 
portant in  the  case  of  syphilitics  with  mucous  patches  in  the  mouth, 
and  in  typhoid  fever  cases. 

Very  ill  patients  on  liquid  diet  should  have  their  nourishment  regu- 


Fic.   83. —  Feeding  Cup. 


WARD  MANAGEMENT  149 

larly  at  night  as  well  as  by  day  unless  there  are  special  orders  that 
the  patient  shall  not  be  awakened.  Very  often  wakefulness  is  due 
to  insufficient  nourishment,  and  a  glass  of  milk  or  a  cup  of  beef  tea 
will  often  secure  several  additional  hours  of  sleep. 

Liquid  diet  includes  only  liquids,  the  most  useful  of  which  are 
milk,  meat  extracts,  broths,  gruels,  albumen  solutions,  and,  last,  but 
not  least,  water. 

Milk  by  reason  of  containing  a  proper  proportion  of  all  the  im- 
portant food  principles  is  by  far  the  most  valuable  single  article  of 
liquid  diet.  It  may  be  given  in  many  forms :  Plain,  peptonized,  as 
buttermilk,  whey,  or  junket;  a  patient  on  milk  diet  alone  should 
take  from  two  to  five  pints  in  the  twenty-four  hours. 

Meat  extracts  have  little  value  except  as  stimulants;  it  should 
never  be  forgotten  that  a  patient  fed  exclusively  on  them  would 
promptly  starve ;  the  same  remark  applies,  in  a  less  degree,  to  broths 
and  gruels.  Albumen  water  is  valuable  when  milk  is  not  tolerated. 
In  all  diseases,  but  especially  in  fevers,  water  in  large  quantities  is 
indispensable ;  it  flushes  out  the  excretory  organs,  removing  poison- 
ous substances,  aids  the  circulation,  and  lowers  temperature  in  its 
evaporation  from  the  skin.  In  all  fever  cases  the  amount  of  water 
given  should  be  noted  on  the  clinical  record. 

Medicines  must  never  be  left  with  a  patient  to  be  taken  by  him ; 
the  nurse  should  give  them  himself  and  see  that  they  are  swallowed 
before  he  leaves  the  bedside.  In  giving  medicines  great  care  must 
be  exercised  to  avoid  mistakes.  The  label  indicating  the  nature 
of  the  medicine  and  the  dose  must  be  carefully  read,  the  bottle 
shaken,  and  the  dose  measured  out  by  pouring  from  the  side  of  the 
bottle  opposite  the  label  so  as  not  to  spoil  the  latter.  After  the  dose 
is  taken  the  fact  should  be  recorded,  never  before.  A  graduated 
medicine  glass  should  always  be  used  to  measure  doses  instead  of 
spoons  which  vary  so  much  in  size.  Medicines  ordered  to  be  taken 
before  meals  should  be  given  about  twenty  minutes  before,  while 
those  to  be  taken  after  meals  should  usually  be  given  immediately 
after.  Sour  medicine  should  not  be  given  within  a  half-hour  of  the 
time  when  milk  is  administered.  Sleeping  patients  should  not  be 
aroused  to  take  medicine  unless  the  medical  officer  has  specially 
so  ordered. 

Pills  are  administered  by  putting  them  far  back  on  the  patient's 
tongue  and  giving  him  a  swallow  of  water. 


150  NURSING 

A  powder  if  small  should  be  placed  on  the  back  of  the  tongue 
and  washed  down  with  water  or  placed  on  a  spoon  and  moistened 
with  water;  if  large  and  bulky  it  should  be  stirred  up  with  water  in 
a  tumbler  and  swallowed  quickly  before  it  settles. 

The  ward  medicine  closet  must  be  kept  locked  and  the  wardmaster 
must  take  care  to  avoid  an  accumulation  of  medicines.  When  a 
patient  for  whom  a  mixture  has  been  especially  ordered  leaves  the 
ward  his  medicine  bottle  should  be  at  once  turned  in  to  the  dis- 
pensary, and  the  same  rule  applies  to  all  medicines  not  in  current  use. 

To  give  medicines  subcutaneously,  the  hypodermic  syringe  is  used. 
Certain  rules  are  necessary  to  prevent  accidents  with  this  instrument. 
The  solution  used  must  be  freshly  prepared;  the  needles  must  be 
clean,  sharp,  and  aseptic;  the  syringe  freshly  sterilized;  the  skin 
where  the  injection  is  made  must  be  cleansed. 

To  render  the  needle  aseptic  boil  it  a  moment  in  a  spoonful  of 
water,  or  draw  phenol  or  cresol  solution  through  it  several  times. 
Disinfect  the  syringe  in  the  same  way,  or  use  70%  alcohol.  Never 
attempt  to  use  a  needle  the  point  of  which  is  dulled  or  bent.  In 
making  the  injection  care  rhust  be  taken  to  avoid  blood-vessels, 
nerves,  and  bones ;  for  this  reason  a  fleshy  part  should  always  be 
selected  and  the  injection  made  obliquely ;  the  outside  of  the  fore- 
arm or  the  front  of  the  thigh  is  usually  chosen. 

Draw  the  medicine  into  the  syringe,  screw  on  the  needle,  hold 
the  syringe  vertically,  needle  up,  and  gradually  press  the  piston 
until  all  air  has  been  forced  out  as  indicated  by  the  escape  of  a  drop 
of  fluid;  wash  the  skin  at  the  point  of  injection  with  a  littlis  alcohol 
or  plain  soap  and  water,  draw  the  skin  tight,  and  thrust  in  the  needle 
quickly.  When  the  needle  has  penetrated  about  half  an  inch,  force 
out  the  liquid  slowly,  withdraw  the  needle,  and  press  the  finger  for 
a  moment  on  the  puncture.  Before  putting  the  syringe  away  draw 
a  disinfecting  solution  through  it,  remove  the  needle,  force  out  the 
last  drop  of  fluid,  and  at  once  insert  the  wire. 

The  bed  pan  should  be  warmed  before  use  by  dipping  it  in  hot 
water  or  placing  hot  water  in  it  for  a  few  minutes ;  as  soon  as  re- 
moved from  the  patient  it  should  be  promptly  covered,  taken  from 
the  ward,  emptied  and  washed. 

Rubber  sheets  should  never  be  folded,  as  to  do  so  will  crack  them ; 
when  not  in  use,  hang  by  the  edges  or  roll  on  a  wooden  roller. 

The  patient's  nails  should  be  kept  clean  and  special  attention  should 


WARD  MANAGEMENT  151 

be  paid  to  his  mouth  and  teeth.  The  teeth  and  mouth  of  helpless 
patients  should  be  washed  with  a  gauze  sponge  dipped  in  a  mild 
antiseptic  solution. 

Dying  patients  should  preferably  be  removed  to  a  separate  room ; 
but  if  this  is  not  practicable  their  beds  should  be  surrounded  by 
screens"  so  that  the  other  patients  may  not  be  unfavorably  affected 
by  the  sight.  A  medical  officer  should  always  be  notified.  As  soon 
as  death  occurs  the  body  should  be  removed  with  as  little  disturbance 
as  possible  and  given  proper  attention. 

The  signs  of  death  are  cessation  of  respiration  and  of  the  heart's 
action,  dilatation  of  the  pupils  with  flaccidity  of  the  cornea,  and 
later  coldness  of  the  body,  rigor  mortis,  and  decomposition. 

When  respiration  can  no  longer  be  seen  its  complete  cessation 
may  b6  verified  by  holding  a  mirror  over  the  mouth ;  if  there  is  any 
breathing  at  all  the  mirror  will  be  clouded.  When  the  heart  and 
pulse  can  no  longer  be  felt,  tying  a  string  around  the  finger  will 
show  whether  the  circulation  has  ceased;  if  it  has  not  there  will  be 
some  congestion  of  the  end  of  the  finger,  while  there  will  be  no 
change  if  death  has  occurred. 

In  hospitals  the  sign  of  death  most  relied  upon  is  the  sudden  and 
permanent  dilatation  of  the  pupils  with  flaccidity  of  the  cornea; 
the  latter  sign  is  elicited  by  touching  the  cornea  with  the  finger,  when, 
instead  of  being  firm  and  resilient,  it  will  be  found  soft  and  flaccid. 

As  soon  as  the  body  is  removed  from  the  ward  the  rectum,  mouth 
and  nostrils  must  be  packed  with  cotton  to  avoid  post-mortem  dis- 
charges, a  triangular  bandage  with  an  absorbent  cotton  pad  applied 
to  the  perineum,  and  the  limbs  straightened  out  and  placed  in  posi- 
tion before  rigor  mortis  or  stiffening  sets  in.  A  little  cotton  should 
be  placed  under  the  upper  lids  which  are  then  closed.  To  prevent 
the  jaw  from  dropping,  a  four-tailed  bandage  is  applied  to  the  chin, 
or  a  rolled-up  bandage  is  fixed  between  the  chin  and  sternum.  The 
body  is  then  wrapped  in  a  sheet  wet  with  an  antiseptic  solution  and 
in  hot  weather  placed  in  an  ice  box. 

Should  an  autopsy  be  necessary  preparations  are  made  for  it. 
The  body  is  placed  on  a  table  in  the  dead-house ;  the  post-mortem 
case  is  procured  and  the  instruments  laid  out;  the  other  arrange- 
ments necessary  are  three  pails,  one  containing  water,  another  to 
receive  discharges,  and  the  third  for  specimens  which  it  may  be 
desired  to  keep;  a  large  bath  sponge,  two  pairs  of  rubber  gloves, 
basin  with  water,  towels,  strong  thread  and  needles. 


CHAPTER   III 

BEDS   AND   BED-MAKING 

The  regulation  hospital  bed  is  of  white  enameled  iron  with  wire 
springs,  and  is  excellent  in  every  way.  The  mattress  is  of  hair  in 
three  sections  fastened  together  by  straps,  so  that  the  soiling  or 
destruction  of  one  section  does  not  necessitate  the  loss  of  the  entire 
mattress ;  further  to  protect  the  mattress  each  is  supplied  with  a 
movable  cover  which  should  always  be  used. 

The  bed  covering  should  be  warm  but  light;  counterpanes  being 
heavy  and  not  porous  are  objectionable,  and  for  occupied  beds 
should  be  replaced  by  sheets. 

To  prepare  a  hospital  bed  first  see  see  that  the  springs  are  in  good 
condition  and  not  sagging;  then  select  a  good  mattress  free  from 
hollows,  cover  it  with  a  mattress  cover,  and  place  on  the  springs. 
Over  the  mattress  spread  a  sheet,  tucking  it  in  first  at  the  head  and 
foot  and  then  at  the  sides. 

If  the  patient  is  liable  to  soil  the  bed  a  dratv  sheet  comes  next, 
otherwise  it  is  omitted.  The  draw  sheet  consists  of  a  rubber  sheet 
about  three  by  four  feet,  covered  by  a  folded  cotton  sheet  and  spread 
across  the  bed  where  the  hips  will  rest,  and  tucked  in  at  the  sides 
or  pinned  to  the  mattress.  Over  this  is  placed  the  upper  sheet  and 
blankets,  and  over  the  latter  for  their  protection  another  sheet  is 
spread;  to  protect  the  upper  edge  of  the  blankets  from  soiling,  the 
outer  sheet  or  spread  is  folded  over  it,  and  finally  the  upper  inside 
sheet  folded  back  over  the  outer  one. 

When  a  patient  is  placed  in  bed  always  pull  out  the  covers  a  little 
at  tTie  foot  of  the  bed,  so  that  they  may  not  press  upon  his  upturned 
feet ;  this  is  a  little  point,  often  neglected,  but  meaning  much  to  the 
patient. 

All  of  the  beds  in  a  ward  should  be  prepared  in  the  same  way 
so  as  to  give  a  neat  and  uniform  appearance.  Patients  are  very 
fond  of  tucking  things  away  under  the  mattress,  a  practice  which 
should  be  carefully  .prevented  by  frequent  search. 

The  bed  linen  of  an  occupied  bed  may  be  changed  easily  by  a 

(152) 


BEDS  AND  BED-MAltiNG  153 

single  nurse  unassisted  and  that  without  seriously  disturbing  the 
patient.  To  change  the  lower  sheet,  first  loosen  all  the  bed  clothes 
at  top,  sides,  and  bottom,  remove  all  the  upper  covering  except  a 
sheet  and  blanket,  and  roll  up  the  bottom  sheet  length  wise  together 
with  the  draw  sheet  into  a  tight  roll  close  to  the  patient's  body ;  then 
in  like  manner  make  one  side  of  the  clean  sheet  and  draw  sheet  into  a 
roll  and  place  it  alongside  the  first  roll,  tucking  the  free  edges  under 
the  mattress.  Now  stand  on  the  other  side  of  the  bed  and  with 
both  hands  turn  the  patient  on  his  side  with  his  face  toward  you; 
tuck  in  the  rolls  under  his  back,  turn  him  back  on  his  other  side 
on  to  the  clean  sheet,  then  withdraw  the  soiled  one  and  pull  the 
clean  sheet  into  place. 

To  remove  the  upper  bedclothing  the  covers  should  first  be  loosened 
as  before,  then  spread  the  clean  sheet  and  blanket  over  them  and 
tuck  in  at  the  sides,  after  which  the  soiled  clothes  may  be  drawn 
out  at  the  foot. 

Bed  linen  should  be  changed  whenever  it  is  soiled,  when  a  patient 
is  discharged,  and  at  least  once  a  week,  depending  on  the  nature 
of  the  case;  in  the  infectious  fevers  it  may  be  necessary  to  change 
daily.  Even  when  the  sheets  are  not  changed  they  should  be  drawn 
tight  and  straightened  up  daily. 

Sometimes  it  is  more  convenient  to  move  the  patient  to  a  fresh 
bed  so  that  the  other  may  be  aired  and  changed;  this  may  be  done 
in  several  ways.  The  two  beds  may  be  moved  close  alongside  of 
each  other  and  the  patient  gently  lifted  over  on  the  sheet  by  two 
attendants,  one  at  the  head  and  the  other  at  the  foot;  the  lifting 
may  be  facilitated  by  rolling  the  edges  of  the  sheet  around  a  pole 
on  each  side,  thus  forming  an  improvised  litter. 

If  there  is  only  one  attendant  a  rubber  sheet  may  be  pinned  to 
the  occupied  bed  and  stretched  across  the  interval  to  form  a  smooth 
surface  on  which  the  patient  is  pulled  over  on  his  own  sheet ;  or 
the  mattress  on  which  the  patient  is  lying  may  be  pulled  a  little  way 
over  the  other  and  the  patient  then  rolled  over  the  edge  or  drawn 
over  on  his  own  sheet.  Where  there  is  only  one  bed  and  the  mat- 
tress is  to  be  changed  draw  the  soiled  mattress  half  way  off,  and 
then  place  the  clean  one  alongside;  draw  the  patient  on  his  sheet 
from  the  soiled  to  the  clean  mattress,  remove,  the  soiled  one,  and 
draw  the  clean  mattress  in  its  place. 

A  bed  is  prepared  for  an  operative  case  the  same  as  for  any  other 


154  NURSING 

with  the  following  differences :  The  pillow  is  removed  and  a  small 
rubber  sheet  covered  by  a  towel  pinned  to  the  mattress  in  its  place, 
this  because  nausea  is  less  apt  to  occur  if  the  head  is  low;  in  case 
there  should  be  vomiting  a  couple  of  towels  are  hung  over  the  head 
of  the  bed  and  a  basin,  several  mouth-wipes  and  a  mouth-gag  or 
tongue  depressor  placed  on  the  bedside  table.  A  number  of  hot- 
water  bags  are  placed  in  the  bed,  and  a  blanket  is  put  under  the 
upper  sheet;  the  object  of  these  procedures  is  to  diminish  shock  by 
having  the  bed  as  warm  as  possible.  Before  the  patient  is  placed  in 
the  bed  the  hot-water  bags  are  removed  lest  the  patient  in  his  un- 
conscious condition  should  be  burned  without  knowing  it.  The 
covers  on  one  side  of  the  bed  should  be  turned  back  to  the  edge  of 
the  mattress  in  order  that  the  bed  may  be  quickly  opened  up  for  the 
reception  of  the  patient. 

Beds  for  fractures  of  the  lower  extremities  should  be  firm  and 
solid  so  that  the  sinking  in  of  the  bed  from  the  weight  of  the  body 
may  not  cause  displacement  of  apparatus  and  in  order  that  the 
patient  may  be  better  handled;  this  is  accomplished  by  placing 
under  the  mattress  a  frame  of  slats  or  a  number  of  separate  wooden 
slats.  A  great  variety  of  fracture  beds  and  invalid  beds  have  been 
invented,  but  they  are  all  too  complicated,  and  an  extemporized  bed 
is  better. 

To  move  a  patient  from  dne  side  of  the  bed  to  another;  standing 
on  the  left  side,  pass  the  right  arm  well  under  the  patient's  shoulder 
and  back,  so  that  his  shoulder  will  rest  upon  that  of  the  nurse,  and 
pass  the  other  hand  over  the  patient's  other  shoulder;  lift  gently  and 
move  over  the  upper  half  of  the  body;  then  place  the  right  arm 
under  the  back  lower  down,  and  the  left  below  the  hips,  and  move 
the  lower  half  of  the  body  over.  Whenever  the  hips  are  to  be  moved, 
always  flex  the  patient's  knees,  and  place  the  feet  upon  the  bed;  this 
enables  the  patient  to  help  and  lighten  the  weight.  When  lifting  the 
shoulders  support  the  head  in  the  hollow  of  your  arm.  When  mov- 
ing the  patient  to  one  side  of  the  bed  always  move  him  toward  you. 

To  lift  to  the  upper  part  of  the  bed  pass  the  right  arm  obliquely 
under  the  patient's  shoulder  and  back  and  the  left  below  the  hips 
and  lift  toward  the  head.  If  the  patient  is  strong  enough  to  clasp 
his  arms  around  the  nurse's  neck  he  can  assist  considerably  in  these 
movements. 


BEDS  AND  BED-MAKING  155 

To  change  the  pUlows  one  arm  should  raise  the  shoulders  and 
head,  while  the  other  hand  adjusts  the  pillows. 

To  raise  the  patient  to  a  semi-recumbent  position  a  bed-rest  may 
be  used;  or  a  straight-backed  chair  turned  bottom  side  up  and 
padded  with  pillows  answers  very  well,  or  the  support  may  be  made 
of  pillows  entirely,  the  first  being  placed  low  down  beneath  the  back 
and  the  others  packed  in  above. 

Where  there  is  a  tendency  to  slip  down  in  bed,  a  firm  cylindrical 
pillow  about  eight  inches  in  diameter  is  used ;  this  is  placed  beneath 
the  patient's  knees  and  firmly  tied  to  the  head  of  the  bed  by  broad 
.bandages  fastened  to  the  pillow  at  each  end. 

Rubber  cushions  of  various  shapes  and  sizes  are  very  useful  about 
a  sick-bed,  and  when  there  are  involuntary  discharges  a  "  Kelly  pad  " 
or  surgical  pad  is  invaluable. 

In  cases  of  paralysis  or  other  cases  requiring  long  confinement  to 
bed  air  mattresses  and  water  mattresses  are  used.  The  air  mat- 
tresses may  be  placed  on  an  ordinary  bedstead  and  inflated  with  a 
bellows  or  by  the  mouth. 

The  water  mattress  requires  a  irame  on  each  side  of  the  bed  to 
keep  it  from  slipping  off,  and  a  rubber  sheet  must  be  spread  over 
the  springs  to  prevent  sticking.  After  the  mattress  is  in  position 
it  is  filled  with  water  by  a  hose  or  through  a  funnel ;  the  temperature 
of  the  water  must  be  not  less  than  98°  F.,  that  is,  the  temperature 
of  the  body.  No  pins  should  be  used  about  water  and  air  beds  lest 
puncture  and  leakage  occur. 

When  patients  are  confined  to  the  bed  for  long  periods  of  time 
and  their  vitality  is  at  the  same  time  very  much  lowered,  as  occurs 
in  cases  of  paralysis,  long-continued  fever,  and  in  old  persons,  bed- 
sores are  very  apt  to  form ;  starting  as  an  inflammation  of  the  skin, 
ulceration  and  sloughing  soon  follow  and  the  destruction  of  tissue 
is  often  very  deep,  even  laying  bare  the  bone  in  many  instances, 
and  this  with  very  little  pain  so  that  the  patient  may  be  unaware 
of  the  existence  of  the  ulcers.  The  causes  of  bed-sores  are  long- 
continued  and  uneven  pressure,  frequent  wetting  of  the  skin,  such 
as  occurs  in  incontinence  of  urine,  and  uncleanliness.  Constant 
watchfulness  is  necessary  to  avoid  them  in  chronic  bed  cases,  espe- 
cially when  the  patient  must  remain  in  one  position.  It  is  much 
easier,  however,  to  prevent  bed-sores  than  to  cure  them.  The  beds 
must  be  kept  clean  and  free  from  crumbs ;  the  sheets  and  the  patient's 


156  NURSING 

night  dress  must  be  drawn  smooth  and  free  of  wrinkles  and  should 
be  changed  whenever  they  get  wet  or  soiled. 

The  parts  of  the  body  most  liable  to  be  affected  are  naturally 
those  most  subjected  to  pressure,  the  lower  part  of  the  back,  the 
shoulders,  elbows,  and  heels.  These  parts  should  be  washed  fre- 
quently with  soap  and  water,  thoroughly  dried,  and  well  sponged 
with  alcohol,  whisky,  or.  a  one-per-cent  solution  of  tannic  acid  in 
whisky.  After  this  lanolin  may  be  rubbed  in  to  make  the  skin 
supple,  followed  by  dusting  with  talcum  or  starch  to  absorb  moisture. 
In  addition,  pressure  should  be  taken  off  the  threatened  points  by 
frequent  changes  of  position  or  the  use  of  rubber  rings;  in  the 
absence  of  rubber  rings  ring-shaped  cushions  may  be  made  of  cotton 
batting  rolled  in  a  tight  cylinder,  formed  into  a  ring,  and  then 
wrapped  with  a  roller  bandage.  In  very  chronic  cases  a  water  or 
air  bed  is  necessary. 

When  the  skin  is  reddened  and  apparently  about  to  break,  it  may 
be  protected  by  strapping  with  adhesive  plaster  or  a  thin  layer  of 
absorbent  cotton  may  be  placed  over  it  and  held  in  place  with  a 
coating  of  collodion. 

After  the  bed-sore  has  formed  it  is  treated  like  any  other  ulcer; 
wet  antiseptic  dressings  are  applied,  and,  after  all  sloughs  have  sepa- 
rated, balsam  of  Peru  or  other  stimulating  applications  are  used. 


CHAPTER   IV 

BATHS  AND   BATHING 

Baths  are  given  for  several  purposes,  among  the  more  important 
of  which  are : 

1.  To  promote  cleanliness. 

2.  To  produce  sweating  or  relaxation. 

3.  To  reduce  fever. 

4.  To  stimulate  the  circulation. 

5.  To  quiet  the  nervous  system. 

6.  For  counter-irritation. 
According  to  temperature  baths  may  be : 

1.  Tepid;  at  temperature  of  the  body;  98°  F. 

2.  Hot;  100°  to  110°  F. 

3.  Cold ;  90°  to  70°  F. 

According  to  extent  baths  are  classified  as: 

1.  General. 

a.  Tub.' 

b.  Sponge. 

2,  Local. 

a.  Sitz  or  pelvic. 
h.  Foot. 

Besides  water  baths,  hot-air  and  steam  baths  are  employed.  The 
wet  pack  is  a  modified  form  of  bath. 

To  promote  cleanliness  tepid  water  is  used  either  in  the  tub  or  by 
sponging. 

To  give  a  sponge  hath  in  bed,  cover  the  entire  bed  with  a  rubber 
sheet;  on  this  place  a  blanket  upon  which  the  patient  lies  with  another 
blanket  or  sheet  over  him ;  provide  a  pail  of  tepid  water,  a  slop  pail, 
basin,  wash  rag,  soap,  towels,  ammonia,  alcohol,  mouth-wash,  orange 
stick,  nail  brush,  cotton,  and  comb.  The  bathing  should  be  quickly 
done  in  sections,  the  rest  of  the  body  being  meanwhile  protected  from 
exposure. 

If  the  purpose  of  the  sponge  bath  is  to  reduce  temperature  the 
water  should  be  cold  and  the  whole  body  may  be  exposed ;  in  such 

(157) 


158  NURSING 

a  case  if  the  patient  seems  chilly  after  the  bath  a  glass  of  hot  milk  or 
a  little  stimulant  may  be  given. 

The  sedative  bath  is  for  the  purpose  of  quieting  excitement  and 
inducing  sleep;  it  may  be  continued  for  hours  or  even  days;  the 
temperature  of  the  water  is  usually  just  below  that  of  the  body  — 
about  96°  F. 

The  arrangement  is  practically  the  same  as  for  the  Brandt  bath, 
but  to  keep  the  water  from  cooling,  the  tub  must  be  covered  with  a 
few  pieces  of  board,  on  which  are  placed  a  rubber  sheet  and  blankets ; 
hot  water  must  be  carefully  added  from  time  to  time  to  maintain  a 
uniform  temperature. 

To  produce  sweating  or  relaxation,  hot-water,  hot-air,  or  steam 
baths  are  used. 

The  hot-water  bath  is  given  in  the  tub  in  the  ordinary  way  except 
that  the  head  is  kept  cool  by  cold  cloths  or  an  ice  bag.     Care  must 


Fig.  84. —  Bed  Cradle  from  Barrel  Hoops. 


be  taken  not  to  continue  the  bath  too  long,  to  the  point  of  fainting; 
fifteen  to  twenty  minutes  is  sufficient,  after  which  the  patient  is 
taken  out  and,  without  drying,  placed  on  hot  blankets  and  covered 
by  three  or  four  more  which  are  wrapped  closely  about  him  up  to 
the  neck.  Hot  weak  tea  or  hot  water  is  given  freely  to  encourage 
sweating.  After  about  an  hour  the  blankets  are  gradually  removed, 
and  the  patient  sponged  off  under  the  last  one  with  alcohol  and 
water,  this  being  followed  by  a  brisk  rub  with  dry  towels. 

Hot-air  and  steam  baths  may  be  given  in  bed  or  sitting  up.  In 
the  first  method  the  bed  is  covered  with  a  rubber  sheet  upon  which 
is  placed  a  blanket  on  which  the  patient  lies  stripped.  Over  his 
body  are  placed  two  or  three  bed  cradles  or  extemporized  bed  cradles 


BATHS  AND  BATHING 


159 


(Fig.  84).  Bed  cradles  may  be  extemporized  by  tying  together 
at  right  angles  two  half  barrel-hoops.  Over  the  cradles  and  tucked 
in  about  the  patient's  neck  is  another  rubber  sheet  and  blanket.  At 
the  foot  of  the  bed  is  placed  an  oil,  gas,  electric,  or  alcohol  heater 
with  a  section  of  stove  pipe  and  an  elbow  to  conduct  the  heat  under 
the  bedclothes,  or,  if  steam  is  to  be  used,  upon  the  heater  is  set  a  tea- 
kettle with  a  hose  attached  to  the  spout  for  the  same  purpose  (Fig. 
85).  After  the  steam  or  hot  hair  has  passed  in  long  enough  to  get 
perspiration  well  started,  the  upper  rubber  sheet  and  the  cradles  are 
removed  and  the  blankets  tucked  in  closely  around  the  patient's  body, 
after  which  the  case  is  managed  in  the  same  manner  as  the  hot-water 
bath. 

To  give  these  baths  to  a  patient  sitting  up,  after  removing  all 
clothing  he  is  made  to  take  his  seat  upon  a  chair  with  perforated 
bottom ;  under  the  chair  is  placed  an  alcohol  lamp,  an  electric  heater, 


Fiq.   85.^  Arrangements  for  Ilot-air  or  Vapor  Baths  in  Bed 


or  a  pail  of  water  in  which  are  dropped  hot  stones  or  bricks.  The 
patient  is  then  surrounded  from  the  neck  downward  by  a  rubber 
sheet  and  blankets  arranged  in  the  manner  of  a  tent;  this  is  a  con- 
venient method  in  the  field. 

Precautions  to  be  used  with  hot  air  or  vapor  baths : 

1.  Be  careful  not  to  burn  or  exhaust  the  patient,  or  to  set  fire  to 

the  bed. 

2.  Keep  an  ice-bag  on  his  head. 

3.  Watch  the  pulse. 

4.  Give  hot  drinks  freely. 

5.  Wrap  the  patient  in  a  hot  dry  blanket  for  an  hour  after  the 
bath,  then  rub  with  alcohol. 

To  reduce  fever  we  use  either  the  Brandt  system  of  cold  tub  baths. 


160  NURSING 

cold  sponging,  or  the  cold  pack.  There  are  also  various  extempo- 
raneous methods  for  applying  cold  for  this  purpose.  The  general 
effect  of  cold  baths,  besides  reducing  the  temperature,  is  to  allay 
nervousness,  quiet  the  circulation,  increase  excretion,  and  induce 
sleep. 

The  Brandt  system  of  bathing  is  used  chiefly  in  typhoid  fever. 
A  portable  bath  tub  on  wheels  is  generally  employed.  The  tub  is 
brought  to  the  bedside  half  filled  with  water  at  a  temperature  of 
about  90°  F. ;  the  naked  patient  is  lifted  from  the  bed  and  lowered 
into  the  tub  feet  first,  and  gradually,  so  as  not  to  produce  too  much 
shock.  For  the  purpose  of  lifting  the  patient  from  the  bed  and 
supporting  him  in  the  tub  an  open-work  stretcher,  a  hammock,  or  a 
cotton  blanket  with  loops  sewed  in  the  edges,  is  usually  employed; 
in  the  absence  of  these  a  binder  eighteen  inches  broad  should  be 
fastened  across  the  head  of  the  tub  to  support  the  head  and  shoulders. 
His  head  rests  upon  a  circular  air  cushion  and  is  kept  covered  with 
cold  compresses ;  pieces  of  ice  are  added  to  the  water  so  as  to  reduce 
the  temperature  gradually  to  about  70°  F.  To  ascertain  the  tem- 
perature accurately  a  bath  thermometer  is  employed.  All  the  time 
the  patient  is  in  the  bath  the  attendants  should  keep  up  a  vigorous 
rubbing  of  his  body.  The  duration  of  the  bath  is  ordinarily  about 
twenty  minutes,  but  it  may  be  shortened  if  there  is  much  shivering, 
and  blueness  of  the  lips  and  finger  tips. 

When  it  is  time  to  take  the  patient  out,  the  tub  is  covered  with 
a  dry  sheet  which  is  wrapped  about  the  patient  as  he  is  lifted  out, 
and  placed  on  a  dry  blanket.  If  shivering  persists  a  hot-water  bag 
may  be  applied  to  the  feet  and  a  hot  drink  may  be  given  internally, 
but  he  should  not  be  wrapped  in  blankets.  The  temperature  is 
taken  in  the  rectum  immediately  after  leaving  the  bath  and  again 
an  hour  later.  Ordinarily  the  bath  is  repeated  whenever  the  tem- 
perature goes  above  102.5°  to  103°  F. 

Cold  sponging  has  already  been  described  under  the  sponge  bath. 

When  the  patient  does  not  stand  the  cold  tub  bath  well  or  is  too 
weak  to  bear  the  moving,  the  cold  pack  may  be  employed.  In  this 
method  the  bed  is  protected  by  a  long  rubber  sheet,  and  two  sheets 
folded  one  or  more  times  and  wrung  out  of  water  at  70°  F.  are 
used.  One  is  placed  under  the  patient  and  the  other  over  him  and 
tucked  in  closely  about  the  body  and  neck ;  or  a  single  sheet  may  be 
used  enveloping  the  entire  body  except  the  head.     The  packs  are 


BATHS  AND  BATHING  161 

changed  about  every  fifteen  minutes,  and  three  or  four  of  them 
generally  produce  the  efifects  of  a  single  tub  bath. 

Bed  tub-bath.  To  give  a  patient  a  bath  in  bed,  pass  under  him  a 
rubber  sheet  the  size  of  the  bed,  a  bed  sheet,  and  over  this  a  large 
rubber  sheet  about  three  feet  wider  and  two  and  one-half  to  three 
feet  longer  than  the  mattress.  Attach  a  small  rope  or  cord  to  the 
head  and  foot  of  the  bed,  on  each  side,  about  six  inches  above  the 
mattress,  and  stretch  it  firmly.  Over  this  cord  pass  the  large  rubber 
sheet  and  fasten  with  clothes  pins,  thus  forming  a  trough  to  carry 
off  the  water;  direct  the  lower  end  of  the  rubber  sheet  into  a  pail 
at  the  foot  of  the  bed,  and  raise  the  head  of  the  bed  a  few  inches 
on  blocks. 

Remove  the  top  covers  and  place  a  towel  over  the  patient.  The 
water,  of  desired  temperature,  may  be  sprinkled  on  with  a  watering 
pot,  or  from  a  pitcher  or  a  syphon  connecting  with  a  pail  placed 
above  the  bed.  If  the  bath  is  cold,  patient  should  be  well  rubbed 
during  its  administration.  After  it  is  over,  drain  off  the  water,  and 
with  a  towel  wipe  the  rubber  sheet  dry,  withdraw  it  from  beneath, 
and  dry  the  patient  with  the  sheet  on  which  he  will  then  lie. 

Alcohol  baths.  The  patient  is  usually  rubbed  with  alcohol  after 
an  ordinary  bath,  or  it  may  be  given  alone,  for  its  soothing  and 
quieting  effect.  Fifty  per  cent  alcohol  is  ordinarily  employed,  and  is 
well  rubbed  in  by  the  hands  of  the  nurse.  The  bedding  covering 
patient,  except  the  sheet,  should  be  removed,  and  the  lower  sheet 
protected  by  bath  towels ;  the  body  is  then  gone  over  systematically, 
one  portion  at  a  time,  using  only  enough  alcohol  to  avoid  wetting  the 
bed.     A  pint  will  usually  be  sufficient  for  one  bath. 

In  the  field  when  the  folding  field  tub  is  not  available,  substitutes 
may  be  extemporized.  An  ordinary  camp  cot  may  be  taken,  the 
canvas  bottom  punched  full  of  holes  and  a  piece  of  rubber  sheeting 
tacked  across  the  frame  below  the  canvas  in  such  a  way  that  it  will 
form  a  gutter  draining  toward  a  pail  placed  at  the  foot.  On  this 
cot  the  patient  is  to  be  placed  and  cold  water  sprinkled  or  poured 
over  him ;  or  an  upright  frame  may  be  made,  to  the  sides  and  ends 
of  which  rubber  sheeting  may  be  attached  in  such  a  way  as  to  form 
an  extemporized  tub. 

Bakes.     Small  hot  air  cabinets  for  baking  different  parts  of  the 
body  are  furnished  by  instrument  makers,  and  especially  adapted  for 
the  part  to  be  baked. 
11 


162  NURSING 

It  is  necessary,  in  the  use  of  these  appliances,  to  strictly  follow 
the  directions  and  to  take  good  care  to  avoid  iDurning  the  patient. 
Special  protectors  are  supplied  for  this  purpose,  but  need  to  be 
closely  watched. 

Electric  light  baths.  Special  appliances  are  required  for  these 
baths,  and  directions  for  their  use  accompany  them. 

Local  baths.  The  foot  bath  may  be  given  in  bed.  It  is  employed 
in  sprains  to  control  the  hemorrhage  about  the  joint,  and  in  internal 
diseases  to  draw  away  the  blood  from  the  congested  part.  For  the 
latter  purpose  mustard  is  usually  added  to  the  hot  water. 

To  give  a  mustard  foot  bath  in  bed  turn  up  the  covers  from  the 
foot  end  of  the  bed,  place  a  rubber  sheet  across  it,  and  on  this  a  pail 
or  foot  tub  full  of  water  as  hot  as  can  be  borne.  Dissolve  a  couple 
of  tablespoonfuls  of  mustard  in  a  cupful  of  hot  water  until  a  uniform 
cream  is  formed  and  stir  it  into  the  pail  of  hot  water.  If  the  dry 
mustard  is  added  to  the  pail  of  water  without  previous  solution, 
particles  of  mustard  will  float  around,  adhere  to  the  legs,  and  may 
produce  blisters. 

When  all  is  ready  the  patient,  lying  on  his  back,  should  flex  his 
legs  and  immerse  them  in  the  hot  solution  until  the  skin  is  quite  red. 
The  legs  are  then  withdrawn,  dried  quickly,  and  wrapped  in  a 
blanket. 

In  the  Sitz  bath  the  patient  sits  in  a  tub  or  deep  basin  of  hot  water, 
the  feet  rest  on  the  floor. 


CHAPTER  V 

ENEMATA,   IRRIGATIONS,   DOUCHES,    CATHETERIZATION 

An  enema  is  an  injection  of  fluid  into  the  bowels.  When  the 
injection  is  made  into  the  rectum  through  a  tube  passed  just  within 
the  anus  it  is  known  as  a  low  enema  or  simply  an  enema ;  when  the 
liquid  is  carried  high  up  into  the  colon  through  a  soft-rubber  tube 
introduced  fifteen  or  eighteen  inches  it  is  known  as  a  high  enema. 

Enemata  are  further  classified  according  to  the  purpose  for  which 
given,  into  laxative,  nutrient,  and  medicinal  or  therapeutic  enemata. 

Laxative  enemata  are  of  various  kinds  according  to  the  special 
indications  of  the  case.  The  one  most  commonly  used  is  composed 
of  two  or  three  pints  of  soap  suds  made  with  any  good  soap  and 
water,  either  hot  or  cold.  To  give  such  an  enema  the  patient  is 
placed  on  his  left  side  with  the  hips  raised  and  resting  upon  a  folded 
towel  placed  upon  a  rubber  sheet  for  the  protection  of  the  bed.  A 
bed  pan  or  commode  should  be  at  hand,  and  also  a  towel  to  control 
the  anus  if  necessary. 

A  rubber  bulb  or  a  fountain  syringe  may  be  used,  the  former 
being  generally  considered  preferable  on  account  of  the  intermittent 
pressure  which  it  permits  of ;  -either,  however,  is  effective  and  safe 
if  properly  used. 

A  soft  rectal  tube  is  attached  to  the  tube  of  the  injector  by  a  short 
piece  of  glass  tubing,  the  rectal  tube  lubricated  with  soft  soap  and 
then  passed  in  gently  for  eight  or  ten  inches.  The  fluid  is  made 
to  pass  in  slowly,  the  bag  in  the  case  of  the  fountain  syringe  being 
raised  or  lowered  as  necessary  so  as  not  to  cause  any  pain. 

After  the  entire  amount  has  passed  in,  the  patient  is  directed  to 
hold  it  for  about  fifteen  or  twenty  minutes  if  possible,  and  may  be 
assisted  by  pressing  a  towel  firmly  against  the  anus.  The  longer 
the  fluid  is  retained  the  higher  up  the  contractions  of  the  bowel 
extend  and  the  more  complete  the  resulting  evacuation.  Should  a 
more  active  enema  be  necessary  thirty  grammes  of  Epsom  salts  and 
fifteen  Cc.  of  turpentine  may  be  added  to  the  soap  suds,  or  sixty  Cc. 
of  castor  oil  and  fifteen  Cc.  of  turpentine  may  precede  the  suds  by 

(163) 


IC^ 


NURSING 


half  an  hour.     Fifteen  Cc.  of  glycerine  diluted  with  an  equal  amount 

of  water,  and  given  with  a 
small  hard-rubber  syringe, 
makes  a  very  effective 
enema. 

The  nutrient  enema  is 
always  given  high,  as  the 
rectum  itself  has  very  little 
absorbent  power  and  still 
less  digestive  capacity;  if 
the  bowels  are  loaded  they 
must  first  be  emptied  by  a 
laxative  enema.  Nutrient 
enemata  must  not  exceed 
one  hundred  and  twenty- 
five  Cc.  in  bulk  so  as  not 
to  cause  peristalsis  and 
lead  to  their  own  rejection  ; 
they  must  also  be  concen- 
trated, nonirritant,  and 
predigested  or  easily  di- 
gestible. They  should  not 
be    repeated    oftener    than 


Fig.    86. — Irrigation   of  the  Bowels.      First  step. 


once  in  four  to  six 
hours. 

Among  the  food  prep- 
arations most  suitable 
for  this  purpose  are 
peptonized  milk  with  or 
without  the  addition  of 
^^  ^^^^  s"d  beef  juice 
or  beef  extract. 

Water  to  relieve  thirst 
is  often  given  by  high 
enema;  for  this  pur- 
pose as  much  as  a  pint 
should  be  used,   and   it 

1         1 J    -L  f    1-     J       A.  Fig.  87. —  Irrigation  of  the  Bowels.     Second  step, 

should  be  of  body  tem- 
perature so  as  to  cause  as  little  irritation  as  possible. 


DOUCHES,  CATHETERIZATION  165 

A  nutrient  enema  is  given  through  a  rectal  tube  or  large  catheter, 
warmed,  well  oiled,  and  introduced  for  about  twelve  to  fifteen  inches ; 
in  the  outer  end  of  the  tube  a  funnel  is  placed,  and  the  liquid  food 
slowly  poured  in  from  a  pitcher.  When  nutrient  enemata  are  given 
frequently  the  bowel  should  be  gently  washed  out  with  warm  water 
before  each  one ;  the  tube  and  funnel  are  used  for  the  washing,  the 
latter  being  alternately  raised  and  lowered  before  all  the  water  has 
run  out  so  as  to  secure  siphon  action. 

Medicinal  enemata  may  be  given  for  their  general  effect  as  when 
chloral,  opium,  or  stimulants  are  used,  or  for  their  local  effect,  on 
inflammation  or  hemorrhage,  when  astringents,  emollients,  or  anti- 
septics are  employed.  The  last  class  of  medicines  is,  however, 
usually  employed  by  irrigation  instead  of  enema.  The  most  common 
emollient  enema  is  the  well-known  starch-and-laudanum  mixture. 
To  prepare  it  take  a  tablespoonful  of  ordinary  laundry  starch,  add 
enough  cold  water  to  dissolve  it,  and  then  sufficient  boiling  water 
to  form  a  thin  paste;  into  this  stir  fifteen  to  twenty  drops  of  lauda- 
num, and  inject  while  warm  with  a  hard-rubber  syringe. 

An  irrigation  differs  from  an  enema  in  that  it  is  desired  that  a 
considerable  portion  of  the  liquid  introduced  shall  be  absorbed  and 
that  the  remainder  shall  be  allowed  to  flow  away  at  once.  The 
irrigation  may  be  given  for  cleansing  purposes  only,  or  disinfectants 
such  as  nitrate  of  silver  or  quinine  may  be  employed.  Before  the 
funnel  is  lowered,  enough  fluid  should  be  introduced  to  gently  dis- 
tend the  bowel  without  causing  pain ;  it  is  important  to  see  that  the 
funnel  is  lowered  while  some  fluid  is  still  visible ;  otherwise  there  is 
difficulty  in  starting  the  outward  flow  (Figs.  86,  87). 

The  tubes  and  syringes  used  in  giving  enemata  and  irrigations 
must  be  kept  thoroughly  clean ;  for  this  purpose,  after  use  a  stream 
of  water  should  be  allowed  to  run  over  and  through  them,  after 
which  the  syringe  should  be  hung  up  to  drip  and  the  tubes  and 
nozzles  placed  in  an  antiseptic  solution.  When  the  tubes  or  nozzles 
have  been  used  in  an  infectious  case  they  should  be  boiled  before 
being  employed  for  another  patient. 

Urethral  injections  are  used  in  gonorrhea.  In  the  hospital  these 
injections  are  given  under  the  supervision  of  the  nurse,  who  should 
instruct  the  patient  how  to  give  them  correctly.  Having  placed  a 
basin  on  a  chair  in  front  of  him  or  standing  in  front  of  the  urinal, 
he  should  first  pass  his  water  to  wash  all  the  pus  out  of  the  urethra. 


166 


NURSING 


The  syringe  is  then  filled  and  the  nozzle  inserted  in  the  meatus  and 
held  there  firmly  with  thumb  and  forefinger  of  the  left  hand,  after 
which  the  piston  is  driven  slowly  home,  the  syringe  withdrawn,  and 
the  urethra  firmly  compressed  for  a  couple  of  minutes  in  order  to 
retain  the  injection.     At  least  two  syringefuls  are  used  each  time, 

A  douche  is  a  stream  or  jet  of  water  propelled  with  some  force. 
Spinal,  vaginal,  nasal,  pharyngeal,  eye,  and  aural  douches  are  em- 
ployed, the  latter  being  the  most  frequently  used  in  military  hospitals. 

The  spinal  douche.  The  patient  should  sit  on  a  board  across  the 
end  of  the  tub  furthest  from  the  spigot  and  with  his  back  toward 
the  spigot.     Use  the  spray  as  directed. 

If  the  spray  is  to  be  hot  test  it  first  on  your  own  arm. 

If  the  patient  is  unable  to 


sit  up  the  douche  may  be 
given  in  bed  which  is  pre- 
pared as  for  a  bed-bath. 

The  nasal  douche.  Use  a 
fountain  syringe  with  a  nasal 
tip.  Incline  the  patient's  head 
forward  and  to  one  side  so 
that  the  nostril  of  entrance  is 
uppermost;  if  one  nostril  is 
obstructed  this  should  be  the 
entrance;  tell  the  patient  to 
keep  the  mouth  open  and 
breathe  through  the  mouth 
and  not  to  cough  or  swallow, 
this  to  prevent  the  passage  of 
the  fluid  into  the  eustachian 
tube;  use  no  force;  hold  the 
irrigator  only  two  or  three 
inches  above  the  patient's 
nose;  have  the  water  hot. 


—  Syringing  the  Ear. 


The  eye  douche.  Use  warm  boric  acid  solution.  Arrange  the 
patient  so  that  the  eye  to  be  douched  is  lower  than  the  other  one ; 
wipe  oflf  any  secretion  with  a  wet  cotton  sponge  from  within  out- 


DOUCHES,  CATHETERIZATION  167 

ward ;  evert  one  lid  and  direct  the  solution  over  it  from  within  out- 
ward, holding  the  basin  in  such  a  position  as  to  catch  the  flow ;  treat 
the  other  lid  in  the  same  way ;  if  drops  are  to  be  put  in  afterward 
place  them  at  the  outer  angle  of  the  eye  so  that  they  will  not  imme- 
diately escape  through  the  tear  duct. 

The  aural  or  ear  douche  is  used  for  cleansing  purposes  or  to 
remove  foreign  bodies,  especially  hardened  wax.  Either  a  fountain 
syringe  with  a  straight  glass  medicine  dropper  or  a  nozzle,  or  a 
hard-rubber  syringe,  is  employed.  The  former  is  to  be  preferred,  as 
the  pressure  can  be  more  easily  regulated. 

To  remove  hardened  wax  a  warm,  five-per-cent  solution  of  soda 
is  employed ;  the  coat  and  collar  of  the  patient  having  been  removed 
and  a  towel  placed  about  his  neck,  he  sits  in  a  chair  with  the  head 
inclined  toward  the  affected  side;  a  basin  or  bowl  is  held  firmly 
against  the  neck  just  below  but  not  touching  the  lobe  of  the  ear;  the 
ear  is  then  drawn  upward  and  forward  to  straighten  the  canal,  and 
the  tip  of  the  nozzle  placed  against  the  upper  wall,  along  which  the 
jet  of  water  is  directed  with  the  object  of  passing  behind  the  plug 
of  wax  and  washing  it  out  in  the  return  flow  along  the  floor  of  the 
ear  (Fig.  88).  A  quart  or  more  of  water  may  be  used  at  a  time 
and  repeated  until  the  mass  comes  away  in  one  piece  or  in  fragments. 
When  the  wax  is  removed  the  ear  should  be  dried  out  with  a  wisp 
of  cotton,  a  little  of  which  is  left  in  the  canal  for  a  day  or  two  until 
the.  sensitiveness  has  subsided. 

Catheterization  is  the  art  of  drawing  off  the  urine  from  the  bladder 
by  the  aid  of  a  catheter.  The  dangers  of  catheterization  are  injury 
to  the  urethra  from  undue  force,  and  cystitis  or  inflammation  of  the 
bladder  caused  by  the  introduction  of  germs  on  an  unclean  catheter. 
The  precautions  to  be  taken  are  absolute  cleanliness  of  everything 
which  may  come  in  contact  with  the  catheter  and  avoidance  of  all 
force  in  introduction.  The  catheter  to  be  used  should  usually  be 
of  soft  rubber  only ;  failing  with  this  a  noncommissioned  officer  may 
use  a  silver  instrument. 

To  introduce  a  soft-rubber  catheter  it  is  first  washed  in  running 
water,  then  wrapped  in  gauze  or  a  towel  and  boiled  five  minutes; 
the  attendant  washes  his  hands  and  the  penis  of  the  patient  with 
hot  water  and  soap,  followed  by  an  antiseptic  solution,  and  surrounds 
the  base  of  the  penis  with  a  clean  towel ;  the  catheter  is  then  lubri- 
cated with  sterilized  oil,  held  in  a  dressing  forseps,  and  gently  passed 


168  NURSING 

in  until  the  escape  of  urine  announces  that  it  has  reached  the  bladder. 
Should  an  obstruction  be  met  with,  the  catheter  is  withdrawn  a 
little,  and  again  pushed  on  as  before.  After  the  flow  of  urine  has 
ceased,  the  instrument  is  gently  withdrawn,  taking  care  to  compress 
the  end  between  the  fingers  as  the  last  portion  is  withdrawn  from 
the  urethra  in  order  to  prevent  the  urine  remaining  in  the  catheter 
dripping  out  on  the  bed.  After  use  the  catheter  should  be  thoroughly 
washed  in  running  water  and  either  hung  up  to  dry  or  placed  in  a 
boric-acid  solution. 

Irrigation  of  the  bladder  for  cystitis  and  other  diseases  is  done  in 
much  the  same  manner  as  irrigation  of  the  intestines,  using  either  a 
single  or  double  current  catheter. 

Catheterization  of  the  ureter  is  always  done  by  the  physician ;  the 
nurse's  duties  are  to  see  to  the  sterilzation  of  the  instruments,  and 
that  specimens  of  the  urine  from  the  two  kidneys  are  kept  quite 
separate,  for  this  purpose  he  marks  the  urethral  catheter  as  well  as 
the  necessary  vessels  "  right  "  and  "  left." 


CHAPTER  VI 

EXTERNAL   APPLICATIONS 

Among  the  external  applications  most  commonly  used  are  heat 
and  cold,  lotions,  counter-irritants,  and  caustics. 

The  application  of  heat  may  be  general  or  local;  the  general 
application  has  already  been  described  in  Chapter  IV.  The  local 
effects  of  heat  are  to  relieve  pain,  allay  inflammation,  and  relax 
spasm.  Dry  heat  is  applied  in  the  form  of  the  various  dry  hot-air 
apparatus,  electric  heaters,  hot-water  bags,  bottles,  or  cans,  salt  bags 
and  hop  bags,  hot  bricks,  etc.  The  dry  hot-air  apparatus  must  be 
used  with  considerable  care  and  according  to  the  directions  which 
accompany  each  appliance.  Bags,  bottles  or  tins  of  hot  water 
should  be  inclosed  in  a  flannel  cover  or  otherwise  wrapped  to  prevent 
danger  of  burning ;  when  used  about  unconscious  or  paralyzed 
patients  especially,  the  greatest  care  and  watchfulness  should  be 
employed  to  prevent  accidents.  Hot-water  bags  should  be  filled  a 
little  more  than  half  full  and  all  the  air  expelled  before  the  top  is 
screwed  on ;  this  makes  them  lighter  and  more  easily  adjusted. 
They  should  be  examined  closely  before  use  to  see  that  they  do  not 
leak.  Hot  bottles  are  not  very  safe,  as  they  are  apt  to  crack  or  burst. 
The  great  advantage  of  bricks  is  that  they  retain  the  heat  a  longtime, 
but  they  are  very  heavy  and  awkward. 

Moist  heat  is  more  penetrating  and  more  relaxing  than  dry  heat. 
It  is  applied  in  the  form  of  poultices  or  fomentations  or  stupes. 

Poultices  are  made  of  various  materials ;  anything  which  will  hold 
heat  and  moisture  is  adapted  to  the  purpose;  flaxseed  meal  is  the 
time-honored  basis  for  poultices,  and  where  the  skin  is  unbroken 
answers  very  well;  but  where  a  wound  or  abrasion  exists  such  a 
poultice  is  a  veritable  culture-bed  for  bacteria,  and  should  be  re- 
placed by  layers  of  gauze  wrung  out  of  a  hot  antiseptic  solution 
and  covered  by  a  layer  of  cotton  batting  and  oil  silk. 

To  make  a  flaxseed  poultice  stir  the  meal  slowly  into  boiling 
water  until  a  thick  paste  is  formed;   boil  for  a  few  minutes,  then 

(169) 


170 


NURSING 


beat  briskly  with  a  spoon  until  the  admixture  of  air  makes  it  light; 
spread  with  a  spatula  or  knife  to  the  thickness  of  one-fourth  or  one- 
half  inch  upon  strong  muslin,  leaving  a  free -border  of  an  inch  all 
the  way  round.  Then  cover  the  face  of  the  poultice  with  gauze, 
or  oil  it  with  vaseline,  and  turn  over  the  edges.  Apply,  and  cover 
with  a  layer  of  cotton  and  oil  silk.  Such  a  poultice  should  be  changed 
once  every  two  or  three  hours.  The  fresh  poultice  should  be  ready 
before  the  old  one  is  removed,  and  they  should  never  be  used  a 
second  time.  Oatmeal  or  cornmeal  will  do  very  well  in  the  absence 
of  flaxseed. 

A  fomentation  or  stupe  consists  of  a  couple  of  layers  of  flannel 
wrung  out  of  hot  water  and  cover  with  cotton  and  oil  silk.  A  few 
drops  of  laudanum  or  turpentine  are  sometimes  sprinkled  upon  the 


Fig.  89. —  Application  of  Cold  Compresses  to  the  Eye. 

flannel  after  it  is  wrung  out,  or  added  to  the  hot  water.  To  prepare 
a  stupe  dip  the  flannel  in  very  hot  water  and  wring  it  out  quickly 
with  a  stupe  wringer  composed  of  a  strip  of  muslin  about  eighteen 
inches  square  with  a  stick  run  through  a  hem  at  each  end;  any 
stupe  which  can  be  wrung  out  with  the  hands  is  not  hot  enough  to 
be  of  much  value.  Stupes  must  be  changed  oftener  than  poultices  — 
about  once  or  twice  an  hour. 

Cold  is  used  locally  to  relieve  pain  and  reduce  inflammation.  It 
may  be  applied  in  the  form  of  compresses,  the  ice  bag,  or  cold  coils. 

Cold  compresses  consist  of  a  couple  of  layers  of  gauze  dipped  in 
ice  water  or  laid  upon  ice  and  afterward  applied  to  the  part;  they 
must  be  renewed  constantly  before  they  get  warm'.     A  large  piece 


EXTERNAL  APPLICATIONS  171 

of  ice  is  placed  in  a  basin  upon  a  towel  or  piece  of  flannel ;  upon  this 
the  compresses,  first  soaked  in  water,  are  placed;  as  a,  fresh  one  is 
taken  the  old  one  is  put  back  upon  the  ice  (Fig.  89). 

The  ice  bag  is  filled  about  half  full  of  finely  crushed  ice  mixed 
with  a  little  salt,  and  care  taken  to  expel  the  air  before  it  is  closed. 
A  layer  of  dry  lint  or  cotton  is  placed  between  the  bag  and  the  skin 
to  prevent  pain  or  even  frost-bite.  Care  must  be  taken  to  refill  the 
bag  before  all  the  ice  melts;  nothing  is  more  common  than  to  see 
neglect  of  this  necessary  rule.  To  crush  the  ice  conveniently  a  stout 
canvas  bag  and  mallet  should  always  be  at  hand. 

Ice-water  coils  are  made  of  rubber  tubing  sewed  upon  a  piece  of 
rubber  sheeting  of  such  size  and  shape  as  to  fit  the  part  to  be  kept 
cool;  several  feet  of  tubing  are  left  free  at  each  end  to  act  as  a 
siphon ;  one  end  is  placed  in  a  pail  of  ice  water  above  the  patient's 
head  and  the  other  in  a  basin  on  the  floor,  and  the  siphon  started. 

Lotions  are  medicated  solutions  used  externally.  Evaporating 
lotions  are  applied  on  a  single  layer  or  two  layers  of  gauze  and  left 
exposed  to  the- air.  With  other  lotions  several  layers  are  used  and 
covered  with  a  protective. 

Counter-irritants  are  substances  used  to  produce  irritation  of  the 
skin  in  order  to  relieve  pain,  congestion,  or  inflammation  in  a  part 
beneath  or  even  at  a  distance;  they  accomplish  this  by  dilating  the 
superficial  blood-vessels,  and  at  the  same  time  by  reflex  action  causing 
a  contraction  of  the  deeper  ones,  thus  drawing  the  blood  away  from 
the  affected  part.  Counter-irritants  are  classified  as :  rubefacients, 
those  causing  only  redness  of  the  skin ;  vesicants,  those  producing 
blisters;   and  the  cautery. 

Mustard,  turpentine,  iodine,  liniments,  and  cups  are  rubefacients. 
Mustard  is  used  in  the  form  of  foot  bath,  poultice,  plaster,  and 
leaves.  The  first  two  have  already  been  described.  A  mustard 
plaster  is  prepared  by  mixing  one  part  of  mustard  with  one  to  five 
parts  of  flour  according  to  the  strength  desired ;  sufficient  tepid  water 
is  slowly  added  to  make  a  smooth  paste,  which  is  then  evenly  spread 
on  paper  or  muslin  and  covered  with  a  layer  of  gauze  or  tissue  paper. 
The  plaster  is  applied  to  the  part  and  held  in  place  by  a  bandage  or 
adhesive-plaster  strips.  Hot  water  or  vinegar  .should  never  be  em- 
ployed in  making  a  mustard  plaster,  as  either  causes  the  evaporation 
of  the  volatile  oil  of  mustard.  The  plaster  should  be  left  on  for 
twenty  minutes  or  a  half-hour,  the  purpose  being  to  produce  redness 


172  NURSING 

of  the  skin.  In  old  persons  and  children  the  effect  should  be  closely 
watched  to  prevent  blistering.  After  removal,  any  adherent  particles 
of  mustard  should  be  wiped  away  and  the  surface  dusted  with 
starch  or  oiled  with  vaseline. 

Mustard  leaves  are  ready  prepared  and  require  only  to  be  dipped 
in  tepid  water  before  use;  the  objection  to  them  is  that  they  have 
usually  lost  their  strength. 

Turpentine  is  used  in  the  form  of  stupes  above  described. 

Iodine  in  the  form  of  tincture  is  painted  on  the  part,  one  or  two 
coats,  with  a  camel's-hair  brush.  Where  the  skin  is  thin  and  moist, 
as  in  the  groin  or  in  young  children,  it  may  blister.  When  the  burn- 
ing caused  by  it  is  excessive  it  may  be  stopped  by  washing  off  the 
iodine  with  alcohol.  The  stain  may  be  removed  by  washing  with 
ammonia  or  thiosulphate  of  soda. 

The  various  stimulating  liniments  have  some  value  as  counter- 
irritants,  though  they  are  chiefly  useful  by  virtue  of  the  massage  by 
which  they  are  applied. 

Dry  cups  act  not  only  as  a  counter-irritant  but  they  also  leave 
an  actual  extravasation  of  blood  beneath  the  skin;  they  cannot  be 
applied  over  bony  or  irregular  surfaces.  The  number  is  usually 
designated,  from  a  dozen  to  a  hundred;  half  a  dozen  or  more  may 
be  in  place  at  a  time  and  they  may  be  left  on  about  five  minutes 
unless  they  drop  off  sooner.  To  apply  them  we  need  a  dozen  cups 
or  small  tumblers,  an  alcohol  lamp,  a  cup  of  alcohol,  a  swab,  matches, 
and  towels.  The  swab  is  prepared  by  wrapping  tightly  with  cotton 
the  end  of  a  small  stick,  probe,  or  wire. 

Dip  the  swab  in  the  alcohol,  light  it,  hold  it  for  a  moment  inside 
the  cup  to  exhaust  the  air,  then  quickly  apply  the  cup  to  the  part; 
repeat  the  motion  as  rapidly  as  possible.  Be  careful  to  avoid  burn- 
ing the  patient  by  dropping  burning  alcohol  upon  him  or  by  undue 
heating  of  the  edges  of  the  cup.  To  remove  the  cup  hold  it  in  one 
hand  and  with  the  index  finger  of  the  other  press  the  skin  just  under- 
neath the  edge  of  the  cup  so  as  to  admit  the  air,  when  the  cup  will 
fall  off.  Before  reaplpying  the  same  cups  they  must  be  wiped  dry 
inside  with  a  towel.  Wet  cupping  is  done  in  the  same  way  as  dry 
cupping  only  the  skin  is  first  scarified  by  means  of  a  special  instru- 
ment known  as  a  scarifier. 

Biers  cups,  which  have  an  attached  rubber  bulb  as  an  exhaust 


EXTERNAL  APPLICATIONS  173 

pump,  are  used  not  only  as  a  counter-irritant,  but  to  relieve  inflamma- 
tion and  pam  by  increasing  the  amount  of  blood  in  a  part. 

Vesication  or  blistering  is  used  when  we  wish  a  more  decided  effect 
than  can  be  obtained  from  rubefacients.  The  principal  vesicant 
is  cantharides  in  the  form  of  plaster  or  collodion.  Before  the  appli- 
cation of  a  blister  the  skin  should  be  washed,  and  shaved  if  neces- 
sary; a  piece  of  plaster  of  the  designated  size  is  then  moistened  with 
a  little  alcohol,  applied  to  the  part,  and  held  in  place  by  a  bandage ; 
strips  of  adhesive  plaster  are  objectionable  because  they  may  exert 
painful  pressure  on  the  blister  as  it  rises. 

The  cantharides  is  left  on  until  a  blister  forms,  usually  eight  to 
ten  hours ;  at  the  end  of  that  time  if  there  is  still  no  blister  the  plaster 
should  be  removed  and  a  poultice  applied;  this  will  usually  raise 
the  blister  promptly.  The  cantharidal  collodion  is  used  by  painting 
on  a  couple  of  coats  and  covering  with  cotton  or  oil  silk.  When  a 
blister  is  required  to  be  raised  quickly  it  is  done  by  soaking  a 
piece  of  lint  with  ammonia  or  chloroform,  applying  it  to  the  part 
and  covering  with  a  watch  glass  or  cupping  glass  to  prevent  evapora- 
tion. A  still  more  prompt  effect  may  be  obtained  from  the  actual 
cautery. 

After  the  blister  is  raised  its  management  will  depend  upon  the 
directions  of  the  physician.  It  may  be  protected  by  a  layer  of  cotton 
and  left  to  be  absorbed  unbroken,  or  it  may  be  punctured  with  a 
sterile  needle  and  the  fluid  allowed  to  escape,  or  the  whole  of  the 
raised  cuticle  may  be  cut  away  and  the  raw  surface  dressed. 

The  actual  cautery  is  simply  a  hot  metal  instrument  applied  to 
the  skin  usually  at  a  cherry-red  heat ;  it  is  used  to  relieve  pain,  cause 
the  absorption  of  effusion,  and  to  control  bleeding.  The  form  used 
in  the  army  is  the  Paquelin  cautery,  an  instrument  in  which  the 
platinum  tips,  first  heated  in  an  alcohol  flame,  are  maintained  in- 
candescent by  pumping  into  them  the  vapor  of  benzine;  it  is  a 
valuable  appliance,  but  requires  care  in  handling,  as  it  readily  gets 
out  of  order.  The  benzine  is  poured  into  the  reservoir  until  the 
lint  or  sponge  which  it  contains  is  just  saturated;  any  free  liquid 
might  get  into  the  tube  and  cause  an  explosion. 

Care  must  be  used  not  to  let  anything  touch  the  tip  while  it  is  hot. 

Among  the  caustics  in  common  use  are  nitrate  of  silver  (lunar 
caustic),  sulphate  of  copper  (blue  stone),  and  nitric  acid. 

Lunar  caustic  is  kept  in  a  caustic  holder;    it  should  be  cleaned 


174  NURSING 

before  use  with  a  piece  of  moist  cotton,  and  dried  after  use ;  it  should 
not  be  allowed  to  touch  the  hands  or  linen,  because  it  makes  a  black 
stain.  To  give  a  point  to  a  stick  of  lunar  caustic  rub  it  on  wet  lint ; 
never  attempt  to  scrape  it. 

Blue  stone  is  used  especially  for  touching  granulated  lids;  the 
crystal  should  be  ground  to  a  point  on  a  fine  stone. 

Nitric  acid  is  used  for  burning  (disinfecting)  chancroids.  Dry 
the  ulcer  and  drop  on  it  a  few  drops  of  four-per-cen<-  solution  of 
cocaine;  after  a  minute  or  two  dry  again,  dip  the  wood  end  of  a 
match  in  the  nitric  acid  and  touch  thoroughly  every  point  of  the 
sore ;  then  pour  cold  water  over  the  part. 


CHAPTER  VII 

TEMPERATURE,    PULSE,    AND   RESPIRATION 

The  normal  temperatnre  of  the  human  body  is  about  98.6°  F. 
{Z7°  C.),  but  the  normal  varies  within  certain  hmits  according  to 
the  part  of  the  body  in  which  the  temperature  is  taken,  and  accord- 
ing to  the  time  of  day.  The  temperature  is  ordinarily  taken  in  the 
mouth,  in  the  axilla,  or  in  the  rectum;  the  axillary  temperature  is 
about  one-fourth  of  a  degree  lower  than  that  taken  in  the  mouth, 
while  the  rectal  temperature  is  a  fourth  to  a  half  a  degree  higher. 
The  highest  temperature  is  usually  recorded  about  four  o'clock  in 
the  afternoon  and  the  lowest  about  two  o'clock  in  the  morning;  the 
difference  may  be  as  much  as  a  degree.  A  variation  of  temperature 
below  97.5°  F.  or  above  99°  F.  may  be  regarded  as  abnormal  and 
an  indication  of  disease. 

Abnormal  temperature  may  be  subnormal  or  elevated. 

Subnormal  temperatures  are  produced  by  anything  which  causes 
a  general  depression  of  the  vital  powers.  Shock,  hemorrhage,  heat 
exhaustion,  exhausting  disease,  may  all  cause  subnormal  tempera- 
ture ;  when  the  depression  of  temperature  is  below  96°  F.  the  con- 
dition is  one  of  collapse. 

Elevation  of  temperature,  or  fever,  means  either  that  more  heat 
is  being  produced  than  usual  or  that  it  is  not  being  gotten  rid  of 
promptly ;  usually  both  conditions  are  present.  You  will  remember 
that  the  evaporation  of  perspiration  is  one  of  the  most  important 
provisions  of  nature  for  regulating  temperature,  and  as  a  matter 
of  fact  in  fever  the  skin  will  usually  be  found  to  be  very  dry.  A 
fever  of  100-103°  F.  is  regarded  as  moderate;  103-105°  F.  as  high 
fever,  while  temperatures  above  105°  F.  are  denominated  hyper- 
pyrexia. 

A  depression  of  temperature  of  several  degrees  is  usually  of  much 
more  importance  than  a  corresponding  elevation ;  thus  a  depression 
of  three  and  a  half  degrees  would  give  a  temperature  of  95°  F.,  or 
the  temperature  of  collapse,  a  condition  which  means  speedy  death 


176  NURSING 

unless  prompt  reaction  takes  place.  On  the  other  hand,  an  elevation 
of  three  and  a  half  degrees  would  only  give  102°  F.,  a  temperature 
by  no  means  alarming.  Hyperpyrexia,  however,  temperatures  106° 
to  109°  F.,  is  very  dangerous,  although  recovery  has  often  followed 
prompt  remedial  measures. 

The  instrument  for  measuring  the  temperature  of  the  body  is 
called  a  clinical  or  self-registering  thermometer.  The  self -register- 
ing feature  is  secured  by  a  break  in  the  mercurial  column  correspond- 
ing to  a  constriction  Jn  the  glass.  When  the  mercury  column  has 
risen  above  the  normal  line,  which  is  usually  indicated  by  an  arrow, 
it  must  be  shaken  down  by  a  sweeping  motion  of  the  arm  before  the 
thermometer  is  used  again. 

The  Fahrenheit  scale  is  usually  employed  in  this  country,  but  the 
thermometers  issued  to  the  army  are  generally  graduated  in  the 
Centigrade  scale  also.  The  normal  in  the  Centigrade  is  ^y°,  40°  C. 
corresponding  to  104°  F.  To  convert  Fahrenheit  degrees  into  Centi- 
grade subtract  32  and  multiply  by  %.  For  example : 
98.6  F.  =  [  (98.6  —  32)  X  %]  =  37°  C. 

Conversely,  to  convert  Centigrade  to  Fahrenheit  multiply  by  % 
and  add  32 ;  example : 

37°  C.  =  [  (37  X  %) +32]  =  98.6°  F. 

When  in  doubt  about  a  thermometer  compare  it  with  one  of 
known  accuracy  by  simultaneous  observations  on  the  same  patient. 

Temperatures  are  ordinarily  taken  in  the  mouth,  the  bulb  being 
placed  under  the  tongue  and  the  patient  directed  to  close  his  lips, 
but  not  his  teeth  upon  it.  If  the  patient  is  very  weak  it  may  be 
necessary  for  the  nurse  to  hold  the  thermometer  in  his  mouth.  With 
modern  thermometers  three  minutes  is  ample  for  mouth  tempera- 
tures. When  the  patient  is  delirious  or  unconscious,  or  is  a  child, 
it  is  not  safe  to  take  the  temperature  in  the  mouth. 

In  infants  and  children  the  temperature  is  usually  taken  in  the 
rectum ;  the  bulb  well  oiled  is  introduced  for  about  an  inch  and  a 
half ;  one  or  two  minutes'  time  is  sufficient. 

To  take  a  temperature  in  the  axilla,  the  arm  pit  is  first  wiped  dry, 
the  bulb  put  in  place  and  the  arm  carried  across  the  chest  so  as  to 
bring  the  opposing  skin  surfaces  in  close  contact  with  the  ther- 
mometer ;  a  Httle  longer  time  is  required  than  in  the  mouth  or  rectum 
—  about  five  minutes  usually. 

Thermometers  when  not  in  use  should  be  kept  in  an  antiseptic 


TEMPERATURE,  PULSE  AND  RESPIRATION       177 

solution  and  resting  on  a  bed  of  cotton ;  bichloride  of  mercury  is 
objectionable  for  this  purpose  as  it  soon  removes  the  markings  on 
the  glass.  Before  using  for  another  patient  the  thermometer  should 
be  rinsed  in  clean  water  and  wiped  dry. 

Fevers  are  classified  as  continued,  remittent,  or  intermittent.  A 
continued  fever  is  one  in  which  the  temperature  is  continually  above 
normal,  and  there  is  a  difference  of  not  more  than  about  one  degree 
between  morning  and  evening;  typhoid  fever  in  the  second  week 
is  usually  a  continued  fever.  In  remittent  fever  there  is  a  decided 
•  drop  some  time  in  the  twenty- four  hours,  but  the  temperature  does 
not  reach  normal.  In  the  intermittent  fevers  the  temperature  at 
certain  intervals  falls  to  or  below  the  normal ;  malarial  fevers  are 
apt  to  be  remittent  or  intermittent. 

In  keeping  a  record  of  fevers  charts  or  thermographs  are  employed. 
Temperatures  are  usually  recorded  morning  and  evening,  but  in 
typhoid  fever  and  other  serious  fevers  this  is  generally  done  every 
three  hours  or  oftener.  In  marking  charts  a  dot  is  placed  on  the 
point  at  which  the  temperature  stands,  and  these  dots  are  connected 
by  straight  lines  drawn  with  the  aid  of  a  ruler. 

The  normal  pulse  rate  in  the  adult  is  about  seventy-two  to  the 
minute;  it  varies,  however,  from  about  sixty-five  to  seventy-five. 
In  children  it  is  much  more  rapid.     In  fevers  it  rises  considerably. 

The  condition  of  the  pulse  is  very  important,  as  it  usually  accur- 
ately indicates  the  condition  of  the  heart  and  vital  powers. 

The  pulse  may  be  taken  by  laying  the  fingers  gently  on  any  super- 
ficial artery,  but  usually  the  raidal  artery  is  the  most  convenient*, 
the  temporal  is  also  frequently  used  for  the  purpose.  The  points 
to  be  noted  are  frequency,  regularity,  intermittence,  fullness,  tension 
and  strength.  Frequency  of  the  pulse  is  increased  by  exercise,  food, 
excitement,  and  position ;  the  pulse  is  more  frequent  in  the  standing 
position  than  when  lying  down  or  sitting. 

An  irritable  pulse  is  one  which  is  easily  excited;  an  intermittent 
pulse  is  one  which  drops  a  beat  now  and  then ;  a  dicrotic  pulse  occurs 
in  extreme  weakness,  as  in  typhoid  fever,  and  consists  of  two  waves 
to  each  beat  so  that  the  rate  may  appear  twice  as  fast  as  the  actual 
pulsations  of  the  heart. 

The  normal  respirations  occur  at  the  rate  of  about  eigtheen  to  the 
minute.  In  disease  there  occur  marked  variations  in  the  frequency 
and  character  of  the  respirations ;  in  narcotic  poisonings  the  respira- 
12 


178  NURSING  ' 

tions  are  very  slow,  while  in  pneumonia  and  peritonitis  they  are  very 
rapid. 

In  taking  respirations  one  should  notice  their  frequency  and 
regularity,  whether  difficult  or  easy,  noisy  or  quiet,  deep  or  shallozv, 
and  whether  symmetrical,  that  is  to  say,  the  same  on  the  two  sides 
of  the  chest. 

Cheyne-Stokes  respiration  is  that  pecuHar  type  of  breathing  which 
occurs  in  certain  diseases  of  the  heart  and  kidneys.  The  respira- 
tions gradually  increase  in  frequency  and  intensity  up  to  a  certain 
point,  then  slowly  decrease  until  they  seem  to  entirely  cease;  after 
a  short  pause  the  same  course  is  gone  through  with  again. 

In  stertorous  breathing  there  is  a  loud  snoring  noise  with  inspira- 
tion. 

Dyspnea  means  difficult  or  painful  breathing. 

In  taking  respirations  it  must  be  remembered  that  they  are  in 
a  measure  under  the  control  of  the  will;  therefore,  they  must  be 
taken  without  the  patient's  knowledge,  and  this  is  done  by  laying 
the  arm  across  the  chest  in  taking  the  pulse,  and  then  without  remov- 
ing the  fingers  from  the  wrist  taking  the  respiration  while  appear- 
ing to  take  the  pulse.  With  a  little  practice  a  nurse  should  become 
so  expert  that  he  can  take  the  pulse  and  respiration  of  a  sleeping 
patient  without  arousing  him. 

In  the  normal  condition,  the  pulse,  temperature,  and  respiration 
rates  have  a  definite  relation  to  each  other,  and  the  three  factors 
should  always  be  considered  together  in  disease,  as  disturbance  in 
the  normal  ratio  may  have  the  most  important  meaning. 

In  health  the  pulse  rate  is  about  four  times  the  respiration  rate ; 
when  the  respiration  rate  is  increased  to  a  third  or  a  half  of  the 
pulse  rate  it  is  usually  an  indication  of  disease  of  the  lungs  such  as 
pneumonia.  In  fevers,  when  the  temperature  rises  the  pulse  becomes 
proportionally  more  rapid ;  if  instead  of  rising  with  the  temperature 
the  pulse  slowly  falls,  an  important  sign  of  yellow  fever  is  present ; 
if,  on  the  other  hand,  the  pulse  rate  becomes  more  rapid  than  that 
which  is  usual  with  a  given  temperature,  it  is  an  indication  of  weak- 
ness and  diminished  vital  powers. 


CHAPTER  VIII 

SYMPTOMS    AND   CLINICAL   RECORD 

One  of  the  most  important  duties  of  a  nurse  is  to  cultivate  the 
habit  of  observing  symptoms  accurately  and  reporting  them  clearly 
and  intelligently. 

The  physician  can  only  be  with  the  patient  a  short  time,  and  he 
must  depend  upon  his  nurse  to  inform  him  of  everything  that  takes 
place  in  his  absence;  the  nurse  may  thus  obtain  information  of 
the  greatest  value  in  diagnosis  and  treatment.  Symptoms  may  be 
divided  into  two  classes  :  subjective  symptoms,  those  which  are  only 
apparent  to  the  patient  himself,  such  as  pain ;  and  objective  symp- 
toms, those  which  are  apparent  to  others,  such  as  redness  and  swell- 
ing. Sometimes  the  symptoms  are  feigned,  when  the  patient  is  said 
to  be  malingering ;  it  is  always  safer  to  assume,  however,  that  the 
symptoms  are  real  until  the  contrary  is  proved. 

Not  only  must  the  nurse  cultivate  the  habit  of  observing  symptoms, 
but  he  must  learn  how  to  attach  to  them  their  relative  importance. 
Emergencies  continually  arise  when  he  must  determine  what  is  to 
be  done ;  are  the  symptoms  of  sufficient  gravity  to  cause  him  to  call 
in  the  noncommissioned  officer  or  send  for  the  surgeon?  Shall  he 
loosen  a  bandage  or  give  a  stimulant  on  his  own  responsibility  ? 

The  observations  should  commence  with  the  giving  of  the  first 
bath  or  putting  the  patient  to  bed.  Are  there  any  scars,  wounds, 
or  eruptions  upon  the  body  ?  Is  the  patient  emaciated  or  dropsical  ? 
Does  he  appear  weak  and  ill?  The  attitude  and  expression  are 
sometimes  characteristic.  In  inflammation  of  one  lung  the  patient 
usually  lies  on  that  side  so  as  to  give  free  play  to  the  uninjured  lung. 
In  appendicitis  or  peritonitis  he  is  apt  to  lie  on  the  back  with  one  or 
both  legs  drawn  up.' 

Slipping  down  toward  the  foot  of  the  bed  means  weakness  and 
is  therefore,  unfavorable. 

With  colic  the  patient  often  lies  on  the  abdomen  with  a  pillow 
pressed  against  it;  but  when  the  pain  is  inflammatory  he  can  not 
stand  the  pressure. 

(179) 


180  NURSING 

When  the  patient  can  not  breathe  while  lying  down  there  is  usually- 
trouble  with  the  heart  or  lungs. 

Great  restlessness  is  often  a  bad  sign. 

An  anxious  look  is  unfavorable,  while  a  tranquil  expression  is  of 
the  opposite  import. 

The  pallor  and  pinched  expression  of  seosis  are  characteristic, 
but  can  not  well  be  described. 

Rattling  in  the  chest,  with  shortness  of  breath  and  a  bluish  tint  of 
the  lips,  is  a  sign  of  edema  of  the  lungs  and  often  indicates  approach- 
ing death. 

The  mental  condition  gives  important  indications:  whether  the 
patient  is  conscious  or  unconscious ;  rational  or  irrational ;  depressed 
or  excited  or  muttering.     The  speech  may  be  thick  or  clear  or  hoarse. 

The  eyes  are  to  be  observed;  whether  the  pupils  are  dilated  or 
contracted  or  unequal ;  whether  there  is  any  squinting ;  any  yellow- 
ness or  congestion  of  the  conjunctiva. 

The  hearing  may  be  painfully  acute  or  it  may  be  defective ;  there 
may  be  a  discharge  from  the  ear. 

Bad  taste  may  be  complained  of  or  offensive  odors. 

The  skin,  especially  of  the  face,  may  give  important  indications ; 
it  may  be  pale,  flushed,  livid,  or  jaundiced;  hot,  cold,  dry,  or  moist. 
A  moist  skin  with  high  temperature  is  usually  a  bad  omen.  A 
peculiar  red  spot  high  up  on  either  cheek  is  often  indicative  of  pneu- 
monia or  consumption ;  pallor  about  the  lips  is  a  sign  of  nausea. 
Then  we  have  the  waxy  hue  of  Bright's  disease  and  the  rashes  of 
the  eruptive  fevers ;  the  sallow  color  of  narcotic  users,  the  pallor  of 
anaemia,  the  blue  tint  of  cyanosis,  the  bronzing  of  Addison's  disease. 
Bluish  spots  about  the  size  of  a  finger  nail  distributed  about  the 
trunk  are  a  sure  sign  of  body  vermin. 

The  tongue  offers  many  valuable  indications;  note  whether  it  is 
dry  or  moist,  clean  or  coated,  large  or  small,  bitten,  or  indented  on 
the  edges  by  the  teeth.  In  malarial  fevers  and  digestive  disorders 
the  tongue  is  apt  to  be  heavily  coated  and  indented  by  the  teeth; 
in  typhoid  fever  it  is  at  first  moist  and  coated,  but  soon  becomes 
dry  and  cracked;  when  such  a  tongue  becomes  moist  and  begins 
to  clean  up  from  the  edges  it  is  a  very  favorable  sign.  In  scarlet 
fever  the  bright-red  papillae  showing  through  the  white  fur  produce 
the  characteristic  strawberry  tongue.  In  yellow  fever  the  tongue  is 
small,  red,  and  pointed. 


SYMPTOMS  AND  CLINICAL  RECORD  181 

Note  at  the  same  time  the  condition  of  the  mouth  and  teeth;  white 
slightly  raised  patches  on  the  inside  of  the  lips  and  cheeks,  at  the 
corners  of  the  mouth,  and  in  the  throat  are  frequently  mucous 
patches,  a  sign  of  syphilis.  The  dark  accumulations  which  occur  on 
the  teeth  in  fevers  are  known  as  sordes;  their  presence  indicates  that 
the  mouth  has  not  been  well  cared  for. 

The  odor  of  the  breath  is  often  significant;  sweet  in  diabetes, 
urinous  in  uraemia,  fetid  in  disorders  of  the  stomach,  gangrene  of 
the  lungs,  bad  teeth,  etc. 

The  state  of  the  appetite  is  of  importance;  it  is  usually  lost  in 
acute  diseases,  but  occasionally  is  excessive.  Observe  with  care 
how  much  food  the  patient  actually  takes.  Nausea  is  often  present 
with  or  without  vomiting.  The  frequency  of  the  vomiting,  whether 
it  is  painful,  and  the  character  of  the  matter  vomited  should  be  noted. 
Usually  the  vomitus  consists  of  food  at  first,  but  this  may  be  followed 
by  bile,  mucus,  or  blood.  When  blood  has  been  retained  in  the 
stomach  some  time  it  becomes  brownish  in  color,  like  cofifee  grounds ; 
vomitus  of  this  character  is  seen  in  yellow  fever.  Vomiting  of  fecal 
matter  is  a  sign  of  great  importance  and  indicates  obstruction  of 
the  bowels.  Great  thirst  is  usually  an  indication  of  fever  or 
hemorrhage. 

The  number  and  character  of  the  stools  should  be  noted.  Blood, 
unless  fresh,  gives  the  stools  a  black,  tarry  appearance;  in  jaundice 
they  are  generally  clay-colored ;  bismuth  and  iron  color  them  black ; 
they  may  be  liquid  or  solid,  and  may  contain  mucus,  pus,  blood,  or 
worms. 

Tenesmus,  a  constant  desire  to  evacuate  the  bowels,  is  present 
in  dysentery. 

Belching  of  gas,  rumblings  in  the  bowels,  and  distention  of  the 
abdomen  are  signs  to  be  noted. 

The  urinarv  functions  should  be  carefully  noted,  and  in  special 
cases  the  amount  passed  carefully  measured.  In  both  suppression 
and  retention  no  urine  is  passed,  but  in  the  former,  which  is  much 
the  more  serious  condition,  no  urine  is  secreted ;  it  may  be  distin- 
guished from  retention,  which  is  caused  by  some  obstacle  to  the 
escape  of  urine  from  the  bladder,  by  the  fact  that  in  suppression 
the  bladder  may  be  shown  to  be  empty  by  tapping  with  the  finger 
just  above  the  pubis ;  a  hollow  sound  is  produced  if  there  is  no  urine 
in  the  bladder. 


182  NURSING 

Incontinence  of  urine,  that  is,  the  inability  to  hold  it,  may  be 
associated  with  retention,  so  that  the  mere  fact  of  constant  dribbling 
does  not  preclude  the  possibility  of  the  bladder  being  distended. 

The  quantity  of  urine  should  be  measured  and  the  frequency 
with  which  it  is  passed  noted.  Useful  information  may  also  be 
obtained  from  observation  of  its  color  and  odor.  Blood  gives  it  a 
smoky  or  red  hue,  pus  a  milky  appearance,  and  mucus  a  stringy 
condition.  Bile  imparts  a  greenish  tinge,  as  does  carbolic  acid, 
while  santonin  gives  a  bright-yellow  color.  Many  drugs  and  vege- 
tables impart  a  characteristic  odor  to  urine. 

Cough  is  an  indication  of  some  irritation  of  the  air  passages ;  the 
matters  coughed  up  are  called  sputa.  When  there  is  no  sputum 
the  cough  is  said  to  be  dry.  The  cough  may  be  tight,  loose,  or 
painful;  then  there  is  the  hoarse,  crowing  cough  of  croup  or  diph- 
theria, the  spasmodic  whoop  of  whooping  cough,  the  wheezing  cough 
of  asthma,  the  painful  cough  of  pleurisy,  and  the  peculiar  rasping 
cough  of  aortic  aneurism.  The  character  of  the  sputum  varies;  in 
bronchitis  it  is  white  or  yellow  and  mucous;  in  pneumonia  it  is 
reddish  and  very  sticky;  in  tuberculosis  it  is  at  first  mucous  and 
frothy,  later  it  is  purulent  with  cheesy  nodules,  and  sometimes 
stained  with  blood. 

In  gangrene  of  the  lung  the  sputum  is  unbearably  offensive. 

Hiccough  when  it  is  persistent  in  the  later  stages  of  acute  diseases 
IS  often  a  very  grave  sign. 

When  a  patient  complains  of  feeling  cold  take  his  temperature; 
a  chill  is  nearly  always  accompanied  by  fever.  Chills  frequently 
accompany  the  onset  of  acute  disease;  when  they  occur  z«  the  course 
of  inflammation  they  often  indicate  suppuration;  in  malaria,  while 
severe,  they  are  not  usually  dangerous. 

Hemorrhage  from  any  part  of  the  body  is  always  significant; 
nose-bleed  is  often  one  of  the  early  signs  of  typhoid  fever. 

Pain  is  one  of  the  most  valuable  signs  which  we  possess,  as  it  often 
points  toward  the  location  of  the  disease.  The  kind  of  pain  should 
be  described  and  whether  it  is  constant  or  intermittent,  severe  or 
slight.  Exaggerated  sensitiveness  to  touch  is  called  hyperesthesia 
and  diminished  sensibility  anesthesia;  the  latter  is  often  associated 
with  loss  of  muscular  power  or  paralysis;  paralysis  of  the  lower 
half  of  the  body  is  called  paraplegia;  of  a  lateral  half  hemiplegia. 

Disorders  of  motion  include  picking  at  the  bedclothes,   always 


SYMPTOMS  AND  CLINICAL  RECORD  183 

a  bad  sign,  twitching  of  the  tendons  (subsultns),  shght  spasms,  and 
local  or  general  convulsions.  In  convulsions  always  note  the  parts 
affected  and  whether  the  attack  is  attended  with  loss  of  conscious- 
ness. 

Under  disoraers  of  consciousness  are  included  delusions  and  hal- 
lucinations, delirium,  stupor,  and  coma. 

The  character  of  the  delusions  should  be  noted,  whether  occa- 
sional or  habitual,  quiet  or  noisy ;  in  stupor  note  whether  the  patient 
can  be  aroused;  if  he  can  not,  it  is  coma,  a  very  serious  condition. 
Coma  vigil  is  a  combination  of  sleeplessness  with  partial  unconscious- 
ness and  is  also  a  symptom  of  bad  omen. 

The  amount  and  character  of  sleep  should  be  recorded;  patients' 
statements  on  this  point  must  be  accepted  with  caution. 

That  nothing  concerning  the  patient's  condition  may  be  forgotten, 
clinical  records  are  kept.  The  blank  forms  for  this  purpose  are  of 
a  uniform  size,  3^"  by  8",  perforated  at  the  top  so  that  on  the  com- 
pletion of  the  case  the  various  sheets  pertaining  to  it  may  be  as- 
sembled and  filed  together. 

Collection  of  specimens.  It  is  usually  necessary  to  keep  speci- 
mens of  urine,  feces,  sputum  or  vomitus,  for  the  inspection  of  the 
visiting  physician.  Ordinarily  these  are  best  kept  in  the  vessel  in 
which  they  are  received.  It  should  be  placed  in  a  cool  place  and 
protected  from  dust. 

If  sterile  specimens  are  needed,  the  vessel  in  which  they  are 
received  to  be  kept,  should  be  sterilized  by  boiling  or  otherwise. 

If  specimens  of  urine  are  to  be  kept  for  any  length  of  time,  it 
may  be  necessary  to  add  a  few  drops  of  formalin  or  chloroform  to 
them,  to  prevent  decomposition. 


184 


NURSING 


CHAPTER   IX 


Fig.  <)t. —  Reef  Knot. 


BANDAGING 

Bandaging  must  be  taught  practically,  one-half  of  the  class  prac- 
ticing on  the  other  half.  Three  general  types  of  bandages  are  used 
in  the  army ;  triangular,  roller,  and  tailed  bandages. 

The  triangular  bandage  possesses  special  advantages  for  the  mili- 
tary service  in  that  it  is  quickly 
and  easily  applied  and  removed. 
The  triangles  are  made  by  tak- 
ing a  piece  of  cheese  cloth  38  to 
41  inches  square  and  cutting  it 
diagonally  into  halves  (Fig.  90). 

The  bandage  is  used  in  three  general  forms :  as  an  open  triangle, 
folded  twice  from  apex  to  base  as  a  broad  cravat,  and  folded  three 
times  as  a  narrow  cravat. 

To   fasten  the  ends  together  the  reef  knot    (Fig.  91)   is  used, 

which  is  much  more  secure  than  the 
"granny"  (Fig.  92). 

Applications  of  the  triangular 
bandage.  Head:  Place  the  base 
of  the  triangle  just  above  the  eyes 
and  let  the  apex  hang  down  over 
the  occiput ;  cross  the  ends  below 
the  occiput,  bring  them  to  the 
front  and  tie  (Fig.  93)  ;  bring 
the  apex  up  over  the  crossed  ends 

Fig.   92.— "  Granny  •■  Knot.  ^^^  pj^    (pjg    ^^y 

Eye:   Use  the  narrow  cravat,  tying  the  ends  behind  (Fig.  95). 

Chin  or  side  of  head  or  face:  Use  the  narrow  cravat,  tying  under 
the  chin  or  on  top  of  the  head.  Or  apply  middle  of  handkerchief 
over  front  of  chin  and  tie  back  of  neck  (Fig.  96). 

Neck:  Use  broad  or  narrow  cravat.  Place  center  of  cravat  over 
dressing,  cross  on  opposite  side  and  tie  in  front  (Fig.  97). 

Chest:   Apply  the  center  of  the  open  triangle  over  the  dressing; 

(185) 


186 


NURSING 


tie  the  ends  on  the  opposite  side,  leaving  one  end  long;  bring  the 
apex  over  the  shoulder  and  fasten  to  the  long  end.  If  the  end  is 
not  long  enough  lengthen  it  by  using  a  narrow  cravat  (Figs.  98  and 
99).  Pelvis:  Apply  the  center  of  the  base  of  the  opened  triangle 
just  below  the  navel;  carry  the  ends  around  to  the  back  and  tie  one 


Fig.   93. —  Triangle   of 
the  Head;  front. 


Fig 


94. —  Triangle 
Head;   rear. 


95. —  Narrow   Cravat   of 
One   Eye. 


end  long ;  bring  the  apex  over  the  perineum  and  between  the  legs  to 
the  rear  and  fasten  to  the  long  end  (Fig.  100). 

Buttocks:  Apply  the  base  of  the  opened  trangle  to  the  lower  part 
of  the  back ;  bring  the  ends  around  the  sides,  crossing  them  in  front, 
and  pin;  split  the  apex  and  fasten  in  front  (Fig.  loi). 

Slings:    The  large  arm  sling  is  applied  in  three  different  ways. 


Fig.  96. —  Narrow  Cravat 
of  Chin  and  Face. 


Fig.   97. —  Narrow  Cravat 
of  Neck. 


In  the  first  method  place  one  end  of  the  triangle  over  the  sound 
shoulder;  the  base  should  be  in  front  and  the  apex  in  rear;  bring 
up  the  front  end  over  the  shoulder  of  the  injured  side  and  tie  ort  the 
side  of  the  neck  ;  bring  the  apex  forward  and  pin  (Fig.  102).  When 
the  collar  bone  is  injured  the  second  form  is  used ;  it  is  applied  in 
the  same  manner  as  the  first  except  that  the  front  end  is  carried 
under  the  arm  pit  instead  of  over  the  shoulder  of  the  injured  side 


BANDAGING 


187 


(Fig.  103).  In  the  third  form  the  rear  end  is  carried  over  the 
shoulder  of  the  injured  side;  otherwise  it  is  the  same  as  the  second 
(Fig.  104).  For  the  small 
sling  the  narrow  cravat  is 
used,  carried  over  the 
shoulders  and  fastened  be- 
hind (Fig.  105). 

Shoulder:  Place  the  apex 
of  the  triangle  on  the 
shoulder;  carry  the  ends 
around  the  arm,  crossing 
them  and  tying  at  the  out- 
side; fold  the  apex  over  a 
sling  or  neck  cravat  and 
pin  (Fig.  105). 

Elbow:     Use     a     broad 

cravat     as      shown     in      Fig.         ^'°-    98.— Triangle   of   the   chest;    front   view. 

105,  or  a  large  arm  sling  (Fig.  102). 

Hand:    Place  the  hand,  palm  up,  on  the  triangle,  ends  of  the 

fingers  toward  the  apex ;  bring  the  apex  up  over  the  palm ;  pass  the 

ends  around  the  wrist 
over  the  apex,  which  is 
then  folded  toward  the 
fingers  and  covered  by 
another  turn  of  the 
ends ;  tie  the  ends  be- 
hind (Fig.  105). 

Hip:  Apply  a  narrow 
cravat  around  the  waist. 
Carry  the  ends  of  the 
triangle,  base  down, 
around  the  thigh  and 
fasten.  Pass  the  apex 
under  the  cravat,  fold 
over  and  tie  (Fig.  106). 
Knee:  Use  the  broad 
cravat ;      cross      behind 


Fig.   99.— Triangle   of   the   Chest;   rear  view. 


and  knot  m  front  below  the  knee-cap;  or  vice  versa   (Fig.   107). 
Foot:  Place  the  foot  on  the  triangle,  toes  toward  the  apex ;  bring 


188 


NURSING 


the  apex  up  over  the  toes  toward  the  ankle ;  cross  the  ends  over  the 
front  of  the  ankle  and  over  the  apex  of  the  bandage,  then  carry 
them  back  around  the  ankle,  crossing  them  behind  in  such  a  manner 

as  to  catch  the  base  of  the  triangle ; 
next  draw  up  the  apex  so  as  to 
tighten  the  bandage  and  fold  it 
over  toward  the  toes.  Bring  the 
ends  forward  and,  crossing  over 
the  ankle  and  apex,  carry  them 
beneath  the  foot  and  tie  on  the  in- 
side (Fig.  io8). 

To  fasten  splints:  Take  a  narrow 
cravat,  double  it  upon  itself ;  place 
i,7vc^B  Bf'  W    the  loop  on  the  outside  of  the  limb; 

carry  the  free  ends  around  the 
limb  and  one  of  them  through  the 
loop ;  then  tighten  as  much  as  neces- 
FiG.  100. —  Triangle  of  the  Pelvis.  sary  and  tie  (Fig.  64). 
Roller  bandages  consist  of  strips  of  cloth  of  variable  length  and 
width.  To  apply  them  properly  requires  care,  time,  and  constant 
practice;  hence  they  have  con- 
siderable less  value  for  first-aid 
purposes  than  has  the  triangular 
bandage. 

The  chief  materials  from 
which  rollers  are  made  are  mus- 
lin, cheese  cloth,  gauze,  flannel, 
and  rubber;  each  has  its  own 
special  qualities. 

The  most  general  and  useful 
sizes  are  as  follows : 

For  the  head,  2  inches  wide 
and  5  yards  long. 

For  the  upper  limb,  23'4  inches 
wide  and  5  to  10  yards  long. 

For  the  trunk,  4  inches  wide  and  5  to  10  yards  long. 
For  the  lower  limb,  3  inches  wide  and  5  to  10  yards  long. 
For  the  fingers,  ^  of  an  inch  wide  and  i  to  2  yards  long. 


Fig.    ioi. —  Triangle  of  the  Buttocks. 


BANDAGING 


189 


Fig.  102. —  Large  Slins  No. 


Roller  bandages  should  be  torn,  not  cut.     To  prepare  a  number  at 

one  time  take  a  piece  of  muslin  of  the  required  length,  tear  off  the 

selvage,  with  the  scissors  split  one  end  into  the  required  widths,  tear 

down   for   a  couple  of    feet, 

separate  the  alternate   strips, 

hand  one   set  to  one  person 

and    the    other    to    another. 

Each   now   pulls    firmly   until 

the    piece    of    cloth    is    torn 

through  the  entire  length. 

Besides  a  machine  for  roll- 
ing bandages   there   are   two 

methods  of  rolling  by  hand. 

Take  a  couple  of  feet  of  the 

end  of  the  bandage  and  fold 

repeatedly  upon  itself  until  a 

firm    mass    is    formed;    then 

sitting  in   a  chair   cover  the 

right  leg,   foot,   and  adjacent 

floor  with  a  clean  towel  or  sheet,  place  the  small  roll  on  the  thigh, 

the  loose  part  of  the  bandage  extending  down  over  the  knee  to  the 

floor,  and  roll  toward  the 
knee;  when  the  roll  reaches 
the  knee  draw  it  up  to  the 
groin  and  then  repeat  the 
motions  (Fig.  109). 

After  a  firm  roll  is  made  in 
this  manner  it  may  be  finished 
by  hand  if  desired ;  in  this 
method  the  bandage  is  grasped 
as  shown  in  Fig.  no  and 
rolled  by  alternate  movements 
of  pronation  and  supination 
of  each  hand. 

Rules    for    bandaging:     i. 
Fig.  103.— Large  Sling  No.  2.  Place  the  limb  in  the  position 

it  is  to  occupy.     If  the  arm  is  bandaged  in  the  straight  position  and 

then  bent,  the  bandage  will  cut  in  at  the  bend  of  the  elbow  and  stop 

the  circulation. 


190 


NURSING 


Fig.   104. —  Large  Sling  No.  3. 


2.  Begirt  at  the  extremity  of  the  limb,  the  ends  of  the  fingers  for 
the  upper  extremity,  the  tips 
of  the  toes  for  the  lower;  if 
this  rule  is  not  followed,  the 
parts  below  the  bandage  will 
swell. 

3.  Place  a  layer  of  cotton 
between  opposed  skin  sur- 
faces, such  as  the  fingers  and 
toes. 

4.  Hold  the  roller  in  the 
right  hand  when  bandaging 
the  left  limb,  and  vice  versa. 

5.  Place  the  outer  surface 
of  the  bandage  on  the  in- 
ner side  of  the  extremity  and 
secure  by  making  a  couple  of  circular  turns. 

6.  Bandage  evenly  and 
neither  too  tight  nor  too 
loose.  Leave  the  tip  of  the 
extremities  exposed  to  ob- 
serve the  state  of  the  circula- 
tion in  the  part.  If  the  blood 
when  pressed  out  of  the  nails 
does  not  promptly  return,  the 
bandage  is  too  tight  and  may 
cause  gangrene. 

Roller  bandages  may  be  ap- 
plied by  circular  turns,  simple 
spirals,  reversed  spirals, 
figure-of-8,  spica,  and  knotted 
turns. 

Circular  turns  and  rapid 
spirals  are  used  chiefly  to  hold 
dressings  in  place ;  the  method 
of  using  them  is  clearly  shown 
in  Fig.  III.  The  slow  spiral 
(Fig.  112)  is  used  where  a 
'imb   is   nearly   cylindrical   in 


Fig.    ios.— Small    Sling,    Triangles   of   the 
Hand,  Elbow,  and  Shoulder, 


BANDAGING 


191 


shape;  each  turn  is  parallel  with  the  turn  below,  which  it  envelops 
for  about  one-third  of  its  width.  For  a  limb  increasing  in  size  like 
the  leg  or  forearm  this  bandage  would  not  lie  evenly,  and  it  becomes 
necessary  to  resort  to  reverses. 

The  method  of  making  the 
reverse  is  shown  in  Fig.  113; 
the  bandage  should  be  held 
loosely  to  give  slack;  the  re- 
verses should  be  in  line  and 
on  the  outside  of  the  limb. 

For  covering  the  joints  the 
figure-of-S  bandage  becomes 
necessary;  as  the  name  im- 
plies, figures-of-8  are  made 
in  alternate  loops  above  and 
below  the  joint ;  each  loop 
covering  in  one-third  of  that 
immediately  below  (Fig.  114). 

The  spica  is  really  a  figure- 
of-8  with  one  loop  much 
larger  than  the  other,  and  is 
used  especially  at  the  hip  and 
shoulder  (Fig.  114). 

The  knotted  turn  is  used 
where  it  is  desired  to  make 
pressure,  especially  on  the  temple 


Fig.   106. —  Triangle  of  the  Hip. 


Fig. 


107. —  Broad  Cravat  of 
the  Knee. 


Unroll  about  a  foot  of  the  band- 
age and  hold  it  against  the  temple;  then 
carry  the  roll  around  the  forehead  and 
occiput;  on  reaching  the  starting  point, 
twist  the  roller  around  to  a  right  angle  and 
carry  it  down  under  the  chin  and  over  the 
vertex;  then  fasten  the  ends  (Vig.  S3)- 
Special  applications  of  the  roller  bandage: 
Recurrent  of  the  head:  Make  a  couple  of 
circular  turns  about  the  forehead  and 
occiput;  reverse  in  front  and  carry  the 
roller  back  to  the  occiput  over  the  middle 
of  the  vertex ;  reverse  again  and  bring  for- 


192 


NURSING 


ward,  covering  in  one-third  of  the  preceding  turn,  continuing  to  carry 
the  roller  backward  and  forward  until  the  head  is  well  covered,  when 
all  the  reverses  are  held  in  place  by  circular  turns  and  pins  or 

sewing.  Until  the  circular  turns  are 
made  all  the  reverses  must  be  held  in 
place  by  an  assistant  (Fig.  115). 

Recurrent  of  a  stump:  Made  in  the 
same  manner  as  the  recurrent  of  the  head 
(Fig.  116). 

Figure-of-S  of  the  eye:  Place  the  end 
of  the  roller  on  the  temple  and  make  a 
Fig.  108.— Triangle  of  the  Foot,  couplc  of  circular  tums  arouud  the  fore- 
head and  occiput,  from  right  to  left  for  the  right  eye,  and  vice  versa 
for  the  left.  Reaching  the  occiput,  pass  from  under  the  right  ear 
up  over  the  right  eye,  across  the 
opposite  temple  and  down  again  to 
the  occiput;  make  as  many  of 
these  turns  as  necessary,  and  finally 
fix  by  circular  turns  (Fig.  117). 

Figure-of-8  of  the  jaw  (Barton's 
bandage) :  Place  the  end  of  the 
roller  below  the  occiput;  pass  ob- 
liquely up  over  the  right  parietal 
bone,  across  the  vertex,  down  over 
the  left  temple  in  front  of  the  ear, 
under  the  chin,  up  over  the  right 
temple  in  front  of  the  ear,  across 
the  vertex,  and  back  to  the  starting 
point.  Then  pass  forward  along 
the  right  side  of  the  jaw  in  front 
of  the  chin  and  back  along  the  left 
side  of  the  jaw  to  the  starting  point. 
These   turns   may   be   repeated   as 

often  as   necessary    (Fig.    118).  Fig.  109.— Roiling  Bandage  on  the  Knee. 

spiral  of  the  chest:  Unroll  about  five  feet  of  the  bandage;  let  the 
free  end  drop  down  over  the  front  of  the  chest  to  about  the  knees  of 


BANDAGING 


193 


the  patient,  carry  the  roller  over  the  opposite  shoulder  to  the  base  of 
the  chest,  then  around  the  chest  over  the  loose  end,  ascending  by  a 
slow  spiral.  When  the  chest 
is  bandaged  as  high  as  neces- 
sary fasten  the  last  turn  by  a 
pin.  Then  bring  up  the  loose 
end  of  the  bandage  over  the 
other  shoulder  and  down  the 
back  to  the  base  of  the  chest 
and  fasten  to  the  lower  and 
upper  turns ;  this  prevents  the 
bandage  from  slipping  down. 
Velpeau  {for  fractured 
clavicle):  Place  the  palm  of 
the  hand  of  the  injured  side  ^'°-  "o--RoiiinK  Bandage  by  Hand. 

on  the  sound  shoulder,  with  padding  between  the  arm  and  chest 
wall.     Place  the  initial  end  of  a. roller  in  the  axilla  of  the  sound 


Fig.    III. —  Rapid  Spiral. 

13 


Fig.   112. —  Slow  Spiral. 


194 


NURSING 


Fig.    113. —  Steps  in  Making  Spiral  Reverses. 


side,  carry  the  bandage 
up  across  the  back,  over 
the  shoulder  of  the  in- 
jured side,  down  the  out- 
side of  the  arm,  under 
the  outside  of  the  elbow, 
and  across  the  front  of 
the  chest  to  the  starting 
point;  repeat  this  turn, 
but  when  the  sound 
axilla  is  reached  the 
second  time  make  a  cir- 
cular turn  around  the 
chest  and  over  the  arm; 
then  repeat  the  first  and 
third  turns  alternately, 
each  layer  of  bandage 
covering  in  about  two- 
thirds  of  its  predecessor. 
Stitch  or  pin  the  points 
of  intersection  of  the 
turns  (Fig.  119). 

Scudde/s  modification 
of  Velpeau:  Commence 
in  the  axilla  of  the  sound 
side  as  in  the  ordinary 
Velpeau,  but  carry  the 
first  and  second  turns 
horizontally  around  the 
front  of  the  chest,  the 
first  under  and  the 
second  over  the  elbow. 
The  third  turn  ascends 
over  the  front  of  the 
chest  to  and  over  the 
injured  shoulder,  down 
the  back  of  the  arm,  un- 
der the  elbow  and  up 
again     over     the     same 


BANDAGING 


195 


Fig.    ii4.-Figure.of.8,   or  Spica  of  the   Shoulder.    Fig.    115— Recurrent  of  the   Head. 

IL 


Fig.  116. —  Recurrent  of  a  Stump. 


Fio.   117. —  Figure-of-8  of  One  Eye.    Fig.   118. —  Figurc-of-8  of  the  Jaw  (Harton's  IJandaRc). 


196  NURSING 

shoulder,  thence  across  the  back  to  the  opposite  axilla,  and  again 
horizontally  around  the  chest,  covering  in  one-third  of  the  previous 
horizontal  turn.  These  movements  are  repeated  until  the  shoulder 
is  reached  (Fig.  120). 

Finger  bandage:  Make  two  turns  about  the  wrist,  pass  diagonally 
over  the  back  of  the  hand  to  the  root  of  the  finger,  descend  by  spiral 
turns  to  the  tip,  make  a  circular  turn,  then  ascend  by  slow  spirals 


Fig.   119. —  Velpeau  of  the  Shoulder. 

or  reverses ;  on  again  reaching  the  base  of  the  finger  cross  the  back 
of  the  hand  to  the  wrist  and  finish  with  a  circular  turn  about  the 
latter  (Fig.  121), 

Foot  bandage:  Make  a  couple  of  circular  turns  around  the  ankle ; 
descend  obliquely  over  the  dorsum,  under  the  sole,  and  back  to  the 
dorsum  of  the  foot,  up  which  the  bandage  must  pass  by  several 
spiral  turns,  covering  the  instep ;  when  this  is  reached,  pass  the 


BANDAGING 


197 


bandage  under  the  point  of  the  heel,  thence  to  the  dorsum,  then 
down  beneath  the  sole,  then  along  the  outer  surface  of  the  heel, 
next  around  the  heel  above  its  point  to  reach  the  instep,  whence] 


Fig.   120. —  Modified  Velpeau. 

passing  to  the  sole,  a  turn  is  made  around  and  above  the  point  of 
the  heel  on  the  inner  side,  again  to  pass  the  instep,  when  the  roller 
must  be  carried  by  spiral  and  reversed  turns  up  to  the  knee  (Fig. 
122). 


Fig.    121. —  Finger   Bandage. 


Tailed  bandages:  Bandages  of  various  widths  split  at  each  end 
are  called  4-tailed  and  are  very  useful  about  the  head.  The  methods 
of  their  application  are  shown  in  Figs.  123  and  124. 


198 


NURSING 


The  T-bandage  is  especially  useful  in  confining  dressings  to  the 
perineum  and  pubic  region ;  it  is  made  by  sewing  a  strip  of  bandage 
to  the  middle  of  another  strip,  the  two  forming  a  right  angle. 

Gauce  bandages,  sterilized,  are  usually  employed  in  aseptic 
dressings. 


Fig.    122. —  Foot  Bandage. 

Flannel  bandages  are  used  when  it  is  desired  to  produce  a  moderate 
degree  of  elastic  pressure,  or  where  warmth  is  necessary.  They 
lie  more  smoothly  than  non-elastic  materials. 

Rubber  bandages  are  of  special  value  when  considerable  pressure 
and  support  are  necessary.  They  must  be  used  with  care  and  fre- 
quently adjusted  and  washed  with  soap  and  water.     They  are  also 


Fig.  123. — Four-Tail  Bandage  for  the  Vortex.      Fig.  124. — Four-Tail  Bandage  for  the  Occiput. 

employed  like  a  tourniquet  to  control  bleeding  and  may  be  very 
quickly  and  effectually  applied  as  follows :  Make  several  circular 
turns  about  the  limb  above  the  bleeding  artery,  then  lift  up  one  of 
the  turns  and  pass  the  unrolled  part  of  the  bandage  under  the  turn 
and  over  the  artery  (Fig.  44). 

Crinoline  is  used  for  fixed  bandages,  especially  the  plaster-of- 
paris  bandage;  gauze  may  also  be  used  for  this  purpose,  but  a  stiffer 


BANDAGING  I99 

material  is  better."  The  bandages  are  prepared  by  placing  on  a 
paper  a  lot  of  freshly  opened  plaster  and  rubbing  it  into  the  meshes 
of  the  material  with  the  hand  while  the  bandage  is  being  loosely 
rolled.  When  the  bandages  are  not  required  for  immediate  use 
they  should  be  wrapped  separately  in  waxed  paper  and  kept  in  a 
warm,  dry  place,  preferably  in  tins.  To  apply,  first  cover  the  part 
with  a  flannel  bandage  or  other  protective,  then  place  a  plaster 
bandage,  end  down,  in  water  sufficient  to  cover  it;  when  bubbles 
cease  to  escape,  squeeze,  the  bandage  gently  and  apply  like  any 
other  bandage.  Each  time  a  bandage  is  taken  out  of  the  water 
place  another  in  so  as  to  have  one  always  ready.  Usually  several 
thicknesses  of  bandage  are  required,  especially  over  the  joints;  when 
necessary  the  dressing  may  also  be  stiflfened  by  strips  of  tin  incor- 
porated in  the  bandage. 

The  floor  should  be  protected  by  sheets  or  newspapers  and  the 
clothing  of  the  patient  and  operator  by  the  use  of  sheets. 

The  limb  must  be  shaved,  washed,  dried,  and  powdered  before  the 
application  of  the  bandage. 

To  remove  plaster  from  the  hands  after  completion  of  the  oper- 
ation, sugar  or  carbonate  of  soda  should  be  added  to  the  water,  or, . 
better,  rubbed  on  the  hands. 

To  remove  plaster  dressings  when  they  are  no  longer  necessary 
is  an  operation  requiring  patience  and  care.  If  the  dressing  is  thin 
plaster  shears  can  be  used,  but  if  it  is  thick  a  strong  knife  or  saw  is 
necessary.  The  track  of  the  knife  or  saw  may  be  softened  somewhat 
by  dropping  into  it  a  little  strong  acetic  acid  or  hydrochloric  acid. 
The  operation  of  removal  is  much  facilitated  if  a  strip  of  tin  has 
been  placed  under  the  plaster,  in  the  line  of  incision,  while  it  was 
being  applied;  the  strip  may  be  cut  down  upon  without  fear  of 
wounding  the  patient. 


CHAPTER   X 

INFECTION    AND  DISINFECTION 

Bacteria  are  the  minute  vegetable  organisms,  so  small  that  they 
can  not  be  seen  except  with  a  microscope,  many  of  which  grow  on 
or  in  the  human  body  and  cause  disease.  The  terms  microbes  and 
germs  are  ordinarily  used  in  the  same  sense  as  bacteria. 

An  infectious  disease  is  one  which  is  capable  of  infecting  other 
persons,  causing  the  same  disease  in  them ;  smallpox  and  malarial 
fever  are  both  infectious.  A  contagious  disease  is  that  form  of  in- 
fectious disease  which  is  spread  to  others  by  contact  with  the  person 
infected.  Smallpox  is  a  contagious  disease.  Malarial  fever  is 
not  a  contagious  disease  because  no  amount  of  simple  contact  with 
an  infected  person  can  produce  the  disease,  the  infection  of  which 
must  be  carried  by  a  mosquito.  Disinfection  is  the  process  of  de- 
stroying the  infectious  germ  or  agent  to  prevent  the  spread  of  the 
disease. 

An  infectious  disease  may  be  due  to  an  animal  or  a  vegetable 
organism ;  in  either  case  the  parasite  is  so  small  as  to  be  visible  only 
under  the  microscope  or  not  visible  at  all. 

Some  of  the  diseases  due  to  animal  parasites  are  malaria,  sleeping 
sickness,  amoebic  dysentery,  and  probably  yellow  fever  and  dengue. 

Sepsis  or  putrefaction  is  a  particular  form  of  infection ;  anti- 
septics are  those  substances  which  prevent  putrefaction  either  by 
destroying  the  germs  or  preventing  their  growth. 

Sterilization  is  the  process  of  killing  disease  germs ;  it  has  the 
same  meaning  as  disinfection,  but  is  usually  limited  to  disinfection 
by  heat. 

In  all  disinfection  work  it  should  be  constantly  borne  in  mind  that 
the  agent  employed  must  be  used  at  the  proper  stretigth,  for  a  definite 
length  of  time,  and  must  be  brought  thoroughly  in  contact  with  all 
parts  of  the  substance  to  be  disinfected. 

The  disinfectants  commonly  used  by  the  medical  department  in 
addition  to  direct  sunlight,  are  dry  heat,  boiling  water,  steam,  cor- 

(200) 


INFECTION  AND  DISINFECTION  201 

rosive  sublimate,  phenol,  cresol,  iodine,  quicklime,  chlorinated  lime, 
formaldehyde  solution,  and  sulphur. 

Dry  heat  is  seldom  used,  as  the  high  temperature  necessary  in- 
jures fabrics,  and  the  heat  has  little  penetrating  power. 

Flowing  steam  is  used  especially  in  the  operating  room  for  dis- 
infecting dressings. 

Boiling  is  a  simple  and  effective  method  of  disinfection  for  metallic 
or  earthen  utensils,  and  for  cotton  or  linen  fabrics.  Woolen  and 
leather  substances  are  injured  by  steam  or  boiling  water.  The  ad- 
dition of  one  per  cent  of  carbonate  of  soda  increases  the  disinfecting 
power  of  the  boiling  water  and  prevents  instruments  from  rusting. 
Actual  boiling  for  ten  minutes  is  ordinarily  sufficient. 

Corrosive  sublimate  in  acid  solution  (0.2  per  cent  hydrocloric 
acid)  is  one  of  the  most  effective  chemical  disinfectants;  for  this 
purpose  solutions  of  corrosive  sublimate  i  :  1000  are  usually  em- 
ployed. Its  disadvantages  are  that  it  is  decomposed  by  albuminous 
matters,  and  by  hard  waters,  and  that  it  corrodes  and  rapidly  de- 
stroys metals.  Solutions  should  be  freshly  prepared,  and  in  soft 
water,  such  as  rain  water  or  distilled  water.  When  only  hard  water 
is  available  some  other  disinfectant  should  be  used. 

Phenol  is  a  valuable  disinfectant  in  five  per  cent  solution.  It, 
like  corrosive  sublimate,  coagulates  albumin  and  thereby  to  some 
extent  protects  the  inclosed  germs  from  its  disinfectant  action. 

Cresol  in  one  per  cent  solution  has  about  the  same  value  as  phenol 
at  five  per  cent.     Albuminous  fluids  do  not  interfere  with  its  action. 

Iodine  in  3-5  per  cent  alcoholic  solution  is  very  valuable  for  dis- 
infecting wounds,  or  sterilizing  the  skin  before  operation. 

Quicklime  is  a  somewhat  uncertain  disinfectant  because  of  the 
fact  that  it  is  rapidly  decomposed  on  exposure  to  the  air  and  moist- 
ure. Milk  of  lime,  a  ten  per  cent  solution  of  quicklime,  is  ordi- 
narily employed.  To  be  effective  the  lime  must  have  been  freshly 
burned  and  be  unslaked. 

Chlorinated  lime  is  used  ordinarily  in  four  per  cent  solution  in 
water.  Its  activity  depends  on  the  amount  of  chlorine  it  contains, 
and,  as  it  is  rapidly  changed  on  exposure  to  the  air,  it  should  have 
been  freshly  opened  and  prepared  in  order  to  be  effective. 

Formalin  is  a  solution  of  formaldehyde  gas  in  water,  its  disinfect- 
ing powers  depending  on  the  dissolved  gas.  It  is  sometimes  used  in 
the  form  of  a  spray,  but  ordinarily  the  gas  itself  is  employed. 


202  NURSING 

The  only  apparatus  required  is  a  large  open  vessel,  protected  by 
some  non-conductive  material  to  prevent  the  loss  of  heat  from 
within.  An  ordinary  milk  pail,  set  into  a  pulp  or  wooden  bucket, 
will  answer  every  purpose,  although  a  special  container  (Fig.  125) 
will  be  found  of  considerable  advantage.  This  container  or  genera- 
tor consists  of  a  simply  constructed  tin  can  with  broad  flaring  top. 
Its  full  height  is  15^^  inches,  the  height  from  the  bottom  to  the 
flaring  top  being  about  8  inches.  The  lower  or  round  section  is  10 
inches  in  diameter,  while  the  flaring  top  is  17^  inches  in  diameter 


Fig.   125. —  Container  for  Generating  Formaldehyde  Gas.     (Formaldehyde-potassium, 
permanganate  method.) 

at  its  top.  The  container  is  made  of  good  quality  of  bright  tin,  is 
supplied  with  a  double  bottom  with  34  inch  air  space  between  the 
two  layers,  and  is  entirely  covered  on  sides  and  bottom  with  asbestos 
paper.  The  asbestos  paper  and  double  bottom  serve  effectively  to 
retain  the  heat  which  is  generated  by  the  vigorous  chemical  reaction 
occurring  within,  and  which  is  essential  to  the  complete  production 
and  liberation  of  the  gas.  This  special  container  can  be  made  by 
any  tinner  of  ordinary  intelligence,  and  costs  but  a  few  dollars. 
The  following  preparatory  steps  should  be  taken  — 

(a)  Have  all  windows  and  doors  (except  door  of  egress)  tightly 
closed.     Securely  paste  strips  of  paper  over  keyholes,  over  cracks. 


INFECTION  AND  DISINFECTION  203 

above,  beneath  and  at  sides  of  windows  and  doors,  over  stove  holes 
and  all  openings  in  walls,  ceiling  and  floor.  If  opening  be  large, 
paste  several  thicknesses  of  paper  over  opening.  Carefully  stop  up 
the  fireplace  if  there  be  one.  There  must  be  no  opening  through 
which  gas  can  escape. 

(b)  All  articles  in  the  room  that  can  not  be  washed  must  be 
spread  out  on  chairs  or  racks.  Clothing,  bed  covers,  etc.,  should 
be  hung  on  lines  stretched  across  the  room.  Mattresses  should  be 
opened  and  set  on  edge.  Window  shades  and  curtains  spread  out 
at  full  length.  If  there  is  a  trunk  or  chest  in  the  room,  open  it  but 
let  nothing  stay  in  it.  Open  the  pillows  so  that  the  gas  can  reach 
the  feathers.    Do  not  pile  articles  together. 

With  the  room  thus  prepared,  as  is  essential  in  any  form  of 
gaseous  disinfection,  crystals  of  potassium  permanganate  (i6  ounces 
to  each  i,cxx)  cubic  feet  of  room  space)  are  placed  in  the  container. 
Over  this  is  poured  *'  formalin,"'  or  the  XjV^  P^^  cent  aqueous  solu- 
tion of  formaldehyde  (i6  ounces  to  every  i,ooo  cubic  feet  of  room 
space),  the  temperature  of  the  room  must  not  be  below  60°  F.  Thef 
formaldehyde  gas  is  promptly  liberated  by  the  vigorous  reaction  of 
the  formalin  and  potassium  permanganate,  and  arises  from  the 
generator  in  immense  volume  in  the  form  of  an  inverted  cone.  It  is 
consequently  necessary  that  all  preparations  be  made  in  advance, 
and  that  the  operator  leave  the  room  at  once  on  the  combination  of 
the  two  chemicals. 

The  door  or  window  of  exit  will  be  promply  closed  and  sealed 
and  the  room  left  closed  for  at  least  four  hours. 

As  in  all  methods  of  disinfecction,  success  largely  depends  upon 
the  care  which  is  exercised  and  the  attention  which  is  given  to  every 
detail.  Simple  as  the  method  is,  neglect  of  any  of  the  following 
points  may  result  in  complete  failure : 

1.  The  room  should  be  sealed  and  prepared  as  described. 

2.  The  potassium  permanganate  (16  ounces  to  every  1,000  cubic 
feet  of  room  space)  should  be  placed  in  the  apparatus  or  generator. 
The  permanganate  must  be  put  in  before  the  formaldehyde  solution. 

3.  The  syj/y  per  cent  formaldeliyde  solution  (16  ounces  to  the 
1,000  cubic  feet  of  room  space)  should  then  be  poured  over  the 
permanganate. 

4.  As  the  gas  is  given  off  in  immense  volume  immediately  after 
the  mixture  of  the  formaldehyde  and  permanganate,  the  operator 


204  NURSING 

must  leave  the  room  at  once.     All  preparations  must  have  been 
finished  in  advance. 

5.  The  door  or  window  of  exit  must  be  promptly  closed  and 
sealed,  so  that  there  will  be  no  escape  of  gas,  and  the  room  should  be 
left  closed  for  four  hours. 

Whenever  practicable,  the  special  generator,  previously  described, 
should  be  used.  In  the  absence  of  such  a  container,  however,  a 
milk  pail  may  be  used.  The  milk  pail  should  be  set,  so  as  to  fit 
snugly  into  a  wooden  or  pulp  bucket,  or  it  may  be  wrapped  tightly 
with  several  layers  of  asbestos  paper.  This  is  done  to  retain  the 
heat  within  the  generator  and  is  very  important  to  the  proper  genera- 
tion of  the  gas. 

Care  must  be  taken  not  to  place  100  much  formaldehyde  in  a 
single  container.  The  reaction  is  violent  and  there  is  great  effer- 
vescence and  bubbling.  If  the  room  is  too  large  to  be  disinfected 
with  one  generator,  use  as  many  more  as  are  required,  and  place  in 
each  only  a  reasonable  amount. 

The  following  quantities  may  be  used  safetly  in  the  containers 
recommended : 

10  or  12  quart  milk  pail,     Formaldehyde,  16  ounces; 

Permanganate,  16  ounces. 

14  quart  milk  pail,  Formaldehyde,  24  ounces; 

Permanganart;e,  24  ounces. 

Special  apparatus  described  above, 

Formaldehyde,  32  ounces; 
Permanganate,  32  ounces. 

Sulphur  fumes  are  valuable  as  a  disinfectant  chiefly  because  of 
their  power  of  destroying  animal  carriers  of  infection  such  as  mos- 
quitoes, fleas,  lice,  and  rats ;  they  also  have  some  value  as  destroyers 
of  bacteria  but  they  injure  metals,  fabrics,  food-stufifs  and  colors. 

Four  pounds  of  rolled  sulphur  are  required  per  1,000  cubic  feet 
of  air  space.  The  room  must  be  tightly  closed  and  all  cracks  and 
openings  sealed ;  the  sulphur  broken  in  small  pieces  is  placed  in  a 
pan  and  a  small  quantity  of  alcohol  poured  over  it;  the  pan  is  then 
placed  on  bricks  in  a  tub  of  water,  the  tub  placed  on  a  table,  not  on 
the  floor,  and  the  alcohol  ignited.  The  water  serves  two  purposes : 
it  increases  the  efficiency  of  the  sulphur  dioxid  by  virtue  of  the 
vapor  liberated  by  the  heat  of  the  burning  sulphur,  and  it  also  lessens 
the  danger  of  fire  (Fig.  126). 


INFECTION  AND  DISINFECTION  205 

Sulphur  candles  can  be  used  instead  of  crude  sulphur,  but  care 
must  be  taken  to  use  sufficient  candles.  The  average  candle  on  the 
market  contains  one  pound  of  sulphur.  Three  of  these  will  be  re- 
quired in  the  disinfection  of  a  small  room,  loxioxio.  Do  not  use 
a  less  number,  no  matter  what  directions  may  accompany  the  candle. 
The  water- jacketed  candle  is  preferable.  Partly  fill  tin  around 
candle  with  water  and  place  candles  in  a  pan  on  the  table,  not  on 
the  floor.  Let  one-half  pint  of  water  be  vaporized  with  each  candle. 
In  the  absence  of  moisture,  the  fumes  of  sulphur  have  no  disin- 
fecting power.     Keep  the  room  closed  for  lo  hours  at  least. 

The  prevention  of  the  spread  of  infectious  diseases  requires  abso- 
lute cleanliness,  free  ventilation,  disinfection,  and  isolation,  and  in  the 


Fig.    126. —  Burning  Sulphur. 

case  of  diseases  such  as  malaria,  yellow  fever,  dengue,  typhus  fever, 
plague,  etc.,  which  are  carried  by  insects,  protection  from  the  insect 
carriers.  In  the  bacterial  diseases  the  infectious  agent  is  usually 
contained  in  one  or  more  of  the  excretions  of  the  patient,  depending 
upon  the  particular  disease.  As  the  bacteria  can  not  get  into  the 
air  from  moist  excretions  these  should  not  be  allowed  to  drv  but 
should  be  disinfected  and  removed  at  once. 

The  dust  of  the  ward  becomes  infected  from  excretory  particles 
which  have  accidentally  become  dried;  hence  every  care  should  be 
taken  to  avoid  raising  dust. 

Flies  and  other  insects  may  carry  the  infection  on  their  feet  or 
other  parts  of  their  bodies,  therefore  the  discharges  should  be  care- 
fully protected  from  insects. 

Sputum  should  be  received  in  covered  cups  contammg  a  one  per 
cent  solution  of  cresol,  or  five  per  cent  formalin.  Sometimes  paper 
cups  are  used,  the  cups  and  contents  being  burned  together. 

Feces  are  best  disinfected  with  milk  of  lime,  ten  per  cent,  or  solu- 
tion of  chlorinated  lime,  four  per  cent. 


206  NURSING  , 

Urine  should  be  sterilized  by  adding  sufficient  carbolic  acid  to 
make  a  five  per  cent  solution,  or  enough  corrosive  sublimate  to  make 
a  solution  of  i  :iooo. 

In  all  cases  the  disinfectant  solution  employed  should  be  equal  in 
bulk  to  the  material  to  be  disinfected  and  should  be  thoroughly  mixed 
with  the  excretion  and  allowed  to  stand  at  least  an  hour. 

The  vessels  which  have  been  used  as  containers  should  be  boiled. 

Infected  clothing  and  bedding  should  be  disinfected  by  steam,  or 
formaldehyde  gas  in  a  tight  chamber,  but  steam  should  not  be  used 
for  woolens.  If  the  infection  is  gross,  as  when  the  bed  linen  of  a 
typhoid  or  cholera  patient  is  soiled  with  feces,  the  articles  should 
be  soaked  in  a  cold  phenol  or  cresol  solution  containing  two  per 
cent  of  soft  soap  for  several  hours. 

Boiling  is  applicable  to  linen  or  cotton  fabrics. 

Mattresses  of  which  the  hair  is  infected  require  steam  under  press- 
ure, the  ticking  having  been  opened  up. 

Metal  beds  should  be  washed  with  five  per  cent  solution  of  carbolic 
acid. 

Disinfection  of  rooms:  The  contents  of  the  room  should  not  be 
removed.  Articles  of  bedding  and  clothing  should  be  hung  on 
lines  or  the  backs  of  chairs  so  as  to  expose  as  much  surface  as 
possible.  The  room  must  then  be  made  practically  airtight  by  sealing 
windows,  doors,  ventilating  openings,  and  all  other  cracks  and  open- 
ings with  strips  of  paper  and  ordinary  flour  paste.  Formaldehyde 
gas  or  sulphuric-acid  gas  is  then  introduced  in  proper  proportion 
and  the  room  kept  sealed  for  twenty-four  hours. 

The  latest  investigations  indicate  that  this  preliminary  fumiga- 
tion is  of  little  value  and  may  be  omitted ;  the  mechanical  cleansing 
is  the  important  feature. 

The  treatment  of  the  walls  and  ceiling  will  depend  upon  their 
nature;  if  hard-finished  or  painted  they  should  be  scrubbed  with  hot 
water  and  soap,  and  then  with  an  acid  solution  of  corrosive  subli- 
mate, i:iooo,  and  repainted;  a  preliminary  scrubbing  of  the  walls 
with  slices  of  stale  bread  is  very  effective  for  mechanical  cleansing; 
bread  so  used  should  be  burned.  If  the  walls  are  calcimined  or 
whitewashed  they  should  be  washed  with  soap  and  hot  water,  fol- 
lowed by  ten  per  cent  solution  of  chlorinated  lime  or  five  per  cent  of 
phenol,  and  recalcimined ;  sublimate  should  not  be  used  because  it  is 
decomposed  by  the  lime.     If  the  walls  are  papered  the  paper  should 


INFECTION  AND  DISINFECTION  207 

be  removed,  after  which  the  treatment  is  the  same  as  for  calcimined 
walls.  Especial  attention  should  be  given  to  the  lower  parts  of  the 
walls,  the  first  six  feet  from  the  floor. 

All  woodwork  is  to  be  scrubbed  with  soap  and  hot  water,  followed 
by  corrosive  sublimate;  painted  or  varnished  woodwork  should  be 
repainted  or  varnished.  Floors  with  hard  finish  should  have  the 
old  finish  removed  with  turpentine  and  a  new  coat  applied. 

After  the  completion  of  the  disinfection  the  room  with  all  doors 
and  windows  open  should  be  freely  exposed  to  the  action  of  sun 
and  air  for  several  days. 

Disinfection  of  tentage:  Everything  should  be  removed  from  the 
tent  for  disinfection  by  the  methods  appropriate  to  each.  The  in- 
terior of  the  canvas,  the  poles,  and  the  wooden  floors,  if  any,  should 
then  be  sprayed  or  washed  with  a  two  per  cent  solution  of  cresol 
or  five  per  cent  phenol.  The  tent  is  then  removed  to  a  new  site, 
pitched  inside  out  and  exposed  to  the  sun  and  air  for  twenty-four 
hours.  The  ground  under  the  old  tent  floor  should  be  policed  and 
scraped,  and  sprinkled  with  a  ten  per  cent  solution  of  chlorinated 
lime  or  freshly  slaked  quicklime. 


CHAPTER  XI 

INSTRUMENTS   AND  APPLIANCES 

The  following  is  a  brief  description  of  those  instruments  and 
appliances  which  require  explanation  : 


Explanation  of  Figs.  127  to  135. 

Atomiser,   hand:    An    instrument    for   producing   a    fine    spray 
(Fig.  127). 

Bistoury:  A  long,  narrow  knife,  which  is  either  straight  or  curved, 
sharp  or  blunt  pointed  (Fig.  128). 

Bougie:  An  instrument  used  for 
dilating  strictures  (Fig.  129). 

Bougie  a  houle:  An  instrument 
used  to  locate  strictures  ( Fig,  1 30) . 

Bougie,  filiform:  A  hairlike 
bougie  for  passing  through  tight 
strictures  (Fig.  131). 

Catheter:  A  tube  for  passing 
through  the  urethra  into  the 
bladder  to  draw  off  the  urine. 
Catheters  are  made  of  silver,  glass 
webbing,  or  rubber,  of  various 
sizes,  and  sometimes  contain  a  wire  called  a  stylet  (Fig.  132). 

Catlin:  A  double-edged  amputating  knife  (Fig.  133). 

Caustic-holder:  A  little  case  for  holding  caustic,  usually  made  of 
gutta-percha  or  silver  ( Fig.  134) . 

Curette:    An  instrument  used  for  scraping  bones  and  unhealthy 
wounds  (Fig.  135). 


Fig.  127. 


(208) 


INSTRUMENTS  AND  APPLIANCES  209 


I 


Fig.  129.      Fig.   130.  Fig.  131. 


Fig.  133. 


Fig.   135- 


Fig.  128. 


Fic.  134. 


14 


210  NURSING 


Explanation  of  Figs.  136  to  139. 

Cutting  shears:  A  strong  scissors  for  cutting  plaster  bandages 
(Fig.  136). 

Clamp,  pile:  Ivory  faced  blades,  to  prevent  burning  of  tissues 
while  using  thermocantery  (Fig.  137). 

Clamp,  tozvel:  Employed  to  secure  the  towel  of  gauze  protector 
to  the  edges  of  the  wound  (Fig,  138). 

Cooler,  prostatic:  For  cooling  and  massaging  the  prostate  gland 
(Fig.  139)- 


INSTRUMENTS  AND  APPLIANCES  211 


Fig.  i3f. 


Fig.  139. 


Fig.  138. 


Fig.  137. 


212  NURSING 


Explanation  of  Figs.  140  to  145. 

Divulsor,  urethral:  For  rapid  dilatation  and  divulsion  of  strictures 
(Fig.  140). 

Director:  An  instrument  with  a  groove  in  which  to  guide  the 
point  of  a  knife  (Fig.  141). 

Drill,  bone:  An  instrument  for  boring  holes  in  bone  (Fig.  142). 

Endoscope,  urethral:  For  examination  of  the  urethra  (Fig.  143). 

Forceps,  bullet:  An  instrument  with  separate  blades  used  for 
extracting  bullets  (Fig.  144). 

Forceps,  dental:    An  instrument  used  for  extracting  teeth  (Fig. 

145)- 


INSTRUMENTS  AND  APPLIANCES 


213 


Fig.  141. 


Fig.  140. 


214  NURSING 


Explanation  of  Figs.  146  fo  151. 

Forceps,  dissecting:  Plain  forceps  used  for  dissecting  purposes 
(Fig.  146). 

Forceps,  dressing:  Forceps  with  scissor  handles,  used  for  remov- 
ing old  dressings  from  wounds  and  sores  (Fig.  147). 

Forceps,  bone  holding:  For  holding  bone  during  operations  (Fig. 
148). 

Forceps:  Ear  dressing  (Fig.  149). 

Forceps:  Nasal  dressing  (Fig.  150). 

Forceps,  steriliser:  For  removing  instruments  from  sterilizer 
(Fig-  151)- 


INSTRUMENTS  AND  APPLIANCES 


215 


Fig.   ISO. 


Fig.  147. 


216  NURSING 


Explanation  of  Figs.  152  to  157. 

Forceps,  tongue:  For  grasping  and  holding  the  tongue  during 
anaesthesia  (Fig.  152). 

Forceps,  gouge:  A  strong  forceps,  cutting  at  the  points,  so  as  to 
gouge  bone  (Fig.  153). 

Forceps,  hemostatic :  Forceps  for  taking  up  articles  (Fig.  154). 

Forceps,  List  on' s  hone:  A  strong  bone  forceps  for  cutting  bone 
in  operations  (Fig.  155). 

Forceps,  mouse-tooth:  Forceps  with  fine,  sharp  teeth,  used  in 
dissecting  (Fig.  156). 

Forceps,  needle -holder:  A  forceps  to  hold  the  needle  in  sewing 
wounds  (Fig.  157). 


INSTRUMENTS  AND  APPLIANCES 


217 


Fig.  IS2- 


Fig.  157- 


218  NURSING 


Explanation  of  Figs.  158  to  164. 

Forceps,  sequestrum:  A  strong  forceps  for  pulling  away  dead 
bone  (Fig.  158). 

Gag,  mouth:  An  appliance  for  holding  the  mouth  open  (Fig.  159). 

Gouge  and  chisel:  For  gouging  and  splitting  bone  (Fig.  160). 

Head  mirror:  A  round  mirror  worn  on  the  forehead  in  the  ex- 
amination of  the  throat  and  ear  (Fig.  161). 

Inflator,  Politzer:  A  rubber  air  bag  with  nozzle  used  in  inflating 
the  ear  (Fig.  162). 

Inhaler,  chloroform:  A  framework  covered  with  gauze  or  flannel 
for  administering  chloroform  (Fig.  163). 

Inhaler,  ether,  Allis:  An  appliance  for  the  administration  of  ether 
(Fig.  164). 


INSTRUMENTS  AND  APPLIANCES 


219 


Fig.  162. 


Fifi.  >('"■ 


Fig.   164. 


220  NURSING 


Explanation  of  Figs.  165  to  175. 

Knife,  amputating:  Used  for  amputating  a  limb;  a  large  one  is 
used  for  amputating  the  thigh,  a  medium  size  for  the  leg,  a  small 
one  for  the  arm  (Fig.  165). 

Knife,  tenotomy:  A  small  narrow  knife  for  cutting  tendons  under 
the  skin  (Fig.  166). 

Lachrymal  probes:  Small  silver  probes  for  introducing  into  the 
tube  or  duct  leading  from  the  eye  to  the  nose  (Fig.  167). 

Lachrymal  styles:  Button-headed  silver  instruments  for  passing 
into  the  duct  leading  from  the  eye  to  the  nose  (Fig.  168).  • 

Lancet:  An  instrument  used  for  bleeding,  vaccinating,  and  open- 
ing boils  or  small  abscesses  (Fig.  169). 

Lavage  tube,  rectum:  A  large,  soft-rubber  tube  for  washing  out 
the  bowel  (Fig.  170). 

Lavage  tube,  stomach:  A  large,  soft-rubber  tube  for  washing  out 
the  stomach  (Fig.  171). 

Needle,  aneurism:  A  curved,  blunt  instrument,  with  an  eye  near 
the  end,  used  for  passing  a  ligature  under  an  artery  (Fig.  172). 

Needles:  (a)  An  ordinary  suture  needle;  (b)  a  cervix  needle; 
(c)  an  intestinal  needle;  (d)  a  perineal  needle.  Needles  are  made 
in  a  very  large  variety  of  styles  and  sizes  (Fig.  173). 

Periosteotome:  An  instrument  for  separating  the  periosteum  from 
bone  (Fig.  174). 

Probe:  A  silver-wire  instrurnent  for  probing  wounds  (Fig.  175)- 


INSTRUMENTS  AND  APPLIANCES 


221 


Fic.  174- 


222  NURSING 


Explanation  of  Figs.  176  to  181. 

Retractor:  An  instrument  for  holding  apart  the  edges  of  wounds 
in  operating  (Fig.  176). 

Saw,  amputating :  A  saw  used  for  sawing  the  bone  in  amputa- 
tions of  the  limb  (Fig.  177). 

Sazv,  Hey's:  A  small  saw  for  cutting  a  piece  out  of  a  bone; 
used  in  operations  on  the  skull  (Fig.  178). 

Sazv,  metacarpal:  A  small,  straight  saw  for  dividing  the  meta- 
carpal bones  (Fig.  179). 

Saw,  plaster  of  Paris:  For  breaking  and  removing  plaster  band- 
ages (Fig.  180). 

Scalpel:  A  short  knife  with  a  convex  edge,  made  in  different  sizes 
and  used  for  cutting  and  dissecting  (Fig.  181). 


INSTRUMENTS  AND  APPLIANCES 


223 


Fig.  i8i. 


Fig.   i8o. 


224  NURSING 


Explanation  of  Figs.  182  to  189. 

Scissors:  Straight  (Fig.  182). 

Scissors,  curved:  .Scissors  having  the  blades  curved  (Fig.  183). 

Scissors,  bandage:  For  cutting  bandages,  etc.  (Fig.  184). 

Sound:  A  metal  instrument  for  dilating  stricture  or  examining 
the  bladder  (Fig.  185). 

Speculum,  ear:  A  more  or  less  conical  cylinder  for  examining  the 
ear.     Usually  in  nests  of  different  sizes  (Fig.  186). 

Speculum,  eye:  An  instrument  for  holding  apart  the  eyelids  (Fig. 
187). 

Speculum,  nose:  A  valved  instrument  for  holding  open  the  nostril 
(Fig.  188). 

Sponge-holder:  An  instrument  for  holding  sponges  when  operat- 
ing in  cavities  (Fig.  189). 


INSTRUMENTS  AND  APPLIANCES 


225 


Fio.   183. 


226  NURSING 


Explanation  of  Figs.  190  to  194. 

Speculum,  rectal:  For  examination  of  the  rectum  (Fig.  190). 

Spud  and  needle,  eye:  For  removing  foreign  bodies  from  the  eye 
(Fig.  191). 

Searcher,  stone:  For  ascertaining  the  presence  of  stones  in  the 
bladder  (Fig.  192). 

Syringe,  urethral:    For  applying  solutions  into  the  urethra  (Fig. 

193)-  _ 

Syringe,  wound  dressing:  Also  used  for  filling  the  bladder  in  con- 
junction with  soft-rubber  catheter  (Fig.  194). 


INSTRUMENTS  AND  APPLIANCES 


227 


Fig.   190. 


Fig.  19a. 


228  NURSING 


Explanation  of  Figs.  195  to  197. 

Stethoscope:  An  instrument  with  which  to  Hsten  to  the  sounds 
of  the  chest  (Fig.  195). 

Syringe,  hypodermic:  A  graduated  glass  or  metal  syringe  fitted 
with  a  hollow  needle,  employed  in  the  injection  of  morphine  and 
other  medicines  beneath  the  skin  (Fig.  196). 

Tenaculum-Forceps:    (Fig.  197). 


INSTRUMENTS  AND  APPLIANCES 


229 


Fig.  195. 


Fig.  197. 


Fig.  196. 


230  NURSING 


Explanation  of  Figs.  198  to  200. 

Thermo-cautery,  Paquelin:  A  cautery  in  which  the  fuel  is  incan- 
descent benzine  (Fig.  198).    . 

Tongue  depressor:  An  appliance  for  holding  down  the  tongue 
in  throat  work  (Fig.  199). 

Tonsillotome:  An  instrument  for  removing  the  tonsils  (Fig.  200). 


INSTRUMENTS  AND  APPLIANCES 


231 


Fig.   199- 


232  .       NURSING 


Explanation  of  Figs.  201  to  205. 

Tourniquet:  An  instrument  for  making  pressure  on  an  artery 
to  stop  the  flow  of  blood  through  it  (Fig.  201). 

Tracheotomy  tubes:  Two  curved  silver  tubes,  one  fitting  inside 
the  other,  used  for  putting  into  the  wind-pipe  when  it  has  been 
opened  by  an  operation  called  tracheotomy  (Fig.  202). 

Trephine:  A  circular  saw  used  in  operations  on  the  skull  (Fig. 
203). 

Trocar  and  cannula:  A  sharp  pointed  instrument  and  sheath  for 
tapping  collections  of  fluid  (Fig.  204). 

Truss:  An  appliance  used  in  the  treatment  of  rupture  (Fig.  205). 


INSTRUMENTS  AND  APPLIANCES  233 


Fig.   201. 


FlC.    202. 


Fig.  203. 


Fig.  204. 


Fig.  20$. 


234  NURSING 


Explanation  of  Figs.  206  to  208. 

Beside  the  above  there  are  certain  special  apparatus  and  cases : 

Apparatus,  compressed  air:  This  consists  of  a  metal  air  container, 
a  force  pump  for  compressing  the  air,  tubing  for  connections,  a 
cut-off  for  controlling  the  escape  of  the  compressed  air,  and  a  set 
of  spray  tubes  (Fig.  206). 

Apparatus,  electric:  This  is  issued  in  several  forms.  The  essen- 
tial parts  are  the  cells,  which  generate  the  current,  the  electrodes  by 
which  it  is  applied,  the  conducting  cords,  and  the  coil  and  inter- 
rupter in  the  case  of  a  faradic  battery  (Fig.  207). 

Apparatus,  restraint:  This  is  contained  in  a  locked  wooden  box, 
and  consists  of  a  bed  strap  which  is  firmly  fastened  to  the  bed  before 
the  patient  is  placed  upon  it ;  a  breast  strap  which  fastens  the  patient 
to  the  bed  strap  and  bed,  anklets,  wristlets,  a  muff,  and  a  set  of  keys, 
by  which  the  buckles  of  the  apparatus  can  be  locked  (Fig.  208). 


INSTRUMENTS  AND  APPLIANCES 


235 


Fic.  io8. 


236  NURSING 


Explanation  of  Figs.  209  to  210. 

Apparatus,  steam  sterilising :^Y or  instruments  and  dressings  (Fig. 
209). 

Apparatus,  infusion:  For  saline  injection  (Fig.  210). 


INSTRUMENTS  AND  APPLIANCES 


237 


Fig.  209. 


Fig.  210, 


238  NURSING 


Explanation  of  Figs.  211  to  213. 

Apparatus,  blood  pressure:  For  determining  the  diastolic  and 
systolic  blood  pressure  in  diagnosis  of  diseases  of  heart,  arteries  and 
kidney  (Fig.  211). 

Bottle,  drop:  For  chloroform  and  ether  (Fig.  212). 

Case,  aspirating:  This  consists  of  a  rubber  stopper  containing 
a  double  current  metal  tube  with  stopcocks,  a  pump,  aspirating 
needles,  trocar  and  cannula,  and  tubing  attachments.  To  use  it  a 
bottle  in  which  the  rubber  stopper  fits  tightly  must  be  supplied; 
the  double  current  metal  tube  is  connected  on  one  side  with  the  pump 
and  on  the  other  with  an  aspirating  needle.  The  air  is  pumped 
out  of  the  bottle,  creating  a  partial  vacuum,  after  which  the  stop- 
cock connecting  with  the  aspirating  needle  is  opened  and  the  fluid 
drawn  off  into  the  bottle  (Fig.  213). 


INSTRUMENTS  AND  APPLIANCES 


239 


Fig.  313. 


240 


NURSING 


Case,  emergency:  This  is  a  case  for  use  of  medical  officers,  con- 
taining a  hypodermic  syringe,  clinical  thermometer,  a  few  simple 
instruments,  and  tablets  of  the  most  useful  medicines. 

In  the  field  everything  is  made  as  light  and  portable  as  possble 
in  order  to  reduce  transportation.  Appliances  and  equipment  are 
packed  in  certain  chests,  cases,  etc.,  which  require  some  description. 

Diagnosis  Tags:  A  book  of  diagnosis  tags  with  a  pencil  attached 
is  contained  in  each  orderly  pouch.  The  diagnosis  tags  are  made 
according  to  the  following  specifications : 

Size  23^2  by  5>^  inches,  provided  with  a  copper  wire  four  (4) 
inches  long  for  fastening  to  the  clothing. 

Material  to  be  linen,  faced  with  paper. 

All  inks  and  colors  used  to  be  "fast." 

Twenty-five  (25)  or  fifty  (50)  to  be  bound  in  a  book  with  paste- 
board covers. 

Form  to  be  as  follows : 


Date  and  hour 

(Blue.) 

is 

0 

(White.) 

in 

Name  and  rank  

Regiment  or  department   

Diagnosis  

Treatment 

Ambulance  station 

Field  hospital  

Signature  

Fig.  214. 

The  following  directions  should  be  printed  on  the  inside  of  the 
cover : 

I.  In  any  wound  or  disease  not  rendering  the  patient  unable  to 
walk,  detach  the  white  body  of  the  tag,  leaving  the  colored  border 
attached  to  the  stub.  In  a  wound  or  disease  rendering  the  patient 
unable  to  walk,  detach  the  entire  tag,  including  colored  border.     - 

It  will  thus  be  always  possible  to  ascertain  by  the  number  of 
colored  borders  left  with  the  stubs  how  many  of  the  patients  treated 
were  or  were  not  able  to  walk. 


INSTRUMENTS  AND  APPLIANCES  241 

2.  Under  "  Diagnosis  "  note  all  essential  facts,  character  of  in- 
jury, parts  involved,  fracture,  etc. 

3.  Under  "  Dressing  Station  "  and  "  Field  Hospital  "  note  any 
additional  treatment  applied.  If  at  either  place  it  is  deemed  best  not 
to  evacuate  a  desperately  sick  or  wounded  patient  any  further,  write 
the  words  "  not  transportable,"  or  the  initials  "  N.T." 

4.  Under  "Remarks"  on  the  back  may  be  noted  any  important 
fact  for  which  there  is  no  room  on  the  face,  whether  operation  or 
treatment  is  urgently  needed,  the  amount  of  stimulant  or  anodynes 
already  administered,  etc. 

5.  Fasten  to  button  on  clothing  of  patient  over  sturnum  or  as 
near  it  as  possible  (Fig.  214). 

Field  desk:  This  is  an  iron-bound  oak  chest,  with  padlock,  in  a 
hinged  case.  It  contains  writing  materials,  blank  books,  and  blank 
forms ;  there  are  two  sizes,  Nos.  i  and  2. 

Food  box:  Contains  hospital  stores  or  containers  for  the  same. 

Commode  chest:  A  box  containing  a  bed  pan,  chamber  pot,  urinal, 
spit  cup,  and  toilet  paper. 

Acetylene  chest:  A  chest  completely  equipped  with  apparatus  for 
illumination  with  acetylene  gas. 

The  regimental  combat  equipment  includes  a  medical  and  surgical 
chest,  a  water  sterilizing  bag.  a  box  of  surgical  dressings  and  other 
necessary  articles  enumerated  in  par.  866  AI.  M.  D. 

Mess  chests:  This  contains  equipment  to  serve  25  persons. 

Belt,  web  ivith  pouch:  This  takes  the  place  of  the  old  hospital 
corps  pouch.  The  pouch  contains  dressing  forceps,  scissors,  pencil 
and  book  of  diagnosis  tags,  while  the  belt  provides  ten  pockets  for 
field  tourniquets,  dressing  packets,  iodine  swabs,  bandages,  sub- 
limated gauze,  adhesive  plaster,  pins  and  aromatic  ammonia. 

Chests,  field  laboratory,  Nos.  i  and  2. 

Chest,  medical  and  surgical,  supplementary. 

Chest,  tableware. 

Saddle,  pouch. 

Venereal  prophylaxis  unit. 
16 


CHAPTER  XII 

THE  OPERATING   ROOM    AND   SURGICAL   NURSING 

In  the  chapter  on  infection  and  disinfection  we  have  already 
spoken  of  bacteria  in  relation  to  disease ;  here  we  must  consider 
them  with  special  reference  to  surgical  infections. 


Fig.  215. 

—  Various  Types  of 

Bacilli. 

Bacteria  may  be  divided  into  two  general  classes,  bacilli  or  rods, 
(Fig.  215),  and  micrococci  or  spherical  bacteria  (Fig.  216)  ;  it  is 
these  latter  that  are  specially  concerned  in  wound  infections.  Mi- 
crococci may  also  be  divided  into  two  classes;    those  which  are 


8  q,%Q  , 

o  00 
000       00 
Fig.  216. —  Staphylococci  and  Streptococci. 


<P 


b 


grouped   in   clusters   like   grapes,    called   staphylococci,   and   those 
arranged  in  chains,  streptococci;  the  former  are  concerned  in  ordi- 

(242) 


OPERATING  ROOM  AND  SURGICAL  NURSING    243 

nary  suppurations  such  as  boils  and  abscesses,  while  the  latter  are 
the  active  agents  in  septicemia  and  erysipelas. 

Some  bacteria  produce  spores  or  seed  which  are  much  harder  to 
kill  than  the  bacteria  themselves. 

We  have  already  seen  that  sepsis  means  putrefaction;  an  aseptic 
wound  is  one  that  is  surgically  clean,  that  is  free  from  all  germs; 
antiseptics  prevent  putrefaction  by  destroying  the  germs  or  prevent- 
ing their  development.  A  wound  offers  just  the  conditions  neces- 
sary for  the  growth  of  bacteria  —  heat,  moisture,  and  abundance 
of  nutritive  material,  and  the  bacteria  are  everywhere  present,  on 
the  skin,  on  the  clothes,  instruments,  and  fingers,  and  in  the  air, 
so  that  if  we  are  to  avoid  infection  minute  care  is  necessary.  All 
disease  germs  in  the  process  of  their  growth  produce  certain  poisons, 
the  nature  and  action  of  which  vary  with  the  particular  germ. 
Yeast,  which  is  really  a  mass  of  germs,  in  its  growth  in  sugar  solu- 
tion produces  alcohol,  which  when  absorbed  causes  intoxication  and, 
if  in  excessive  amounts,  death.  The  nux-vomica  plant  in  its  growth 
produces  strychnine,  one  of  the  most  powerful  of  all  poisons.  So 
with  disease  germs.  The  staphylococci  in  a  wound  cause  inflam- 
mation and  suppuration ;  if  the  poison  is  absorbed  fever  results, 
toxemia  or  hlood  poisoning.  Streptococci  have  the  same  effect,  and 
in  addition  frequently  invade  the  blood  themselves  and  grow  there, 
producing  septicemia,  pyemia,  and  death. 

Pyemia  differs  from  septicemia  only  in  that  abscesses  form  at  a 
distance  from  the  original  infection,  especially  in  the  joints,  muscles, 
and  lungs ;  the  abscesses  are  caused  by  the  pus  cocci  which  reach 
those  points  through  the  blood. 

The  most  important  point  in  surgical  nursing  is  absolute  cleanli- 
ness on  the  part  of  the  nurse ;  a  nurse  with  dirty  hands  and  finger- 
nails is  an  abomination  and  should  not  be  tolerated  for  a  moment. 
It  should  be  borne  in  mind  that  surgical  infections  are  readily  carried 
from  one  patient  to  another,  and  thorough  cleansing  and  disinfection 
of  the  hands  before  dressing  each  case  should  be  an  invariable  rule. 

The  preparation  of  a  patient  for  a  major  operation  usually  begins 
the  night  before,  when  a  laxative  is  given  followed  by  an  enema 
early  in  the  morning  of  the  operation. 

About  twelve  hours  before  the  operation  the  field  of  operation 
and  the  surrounding  skin  are  shaved  and  then  washed  with  hot 
water  and  soap;    about  six  hours  before  the  operation  the  skin  is 


244  NURSING 

wiped  dry  with  a  sterile  towel  and  then  moistened  with  tincture  of 
iodine,  and  covered  with  dry  sterile  gauze. 

If  the  operation  is  done  in  the, morning  no  food  is  given  after  the 
light  supper  of  the  previous  night,  except  perhaps  an  early  cup  of 
coffee.  The  urine  is  passed  or  drawn  the  last  thing  before  going  to 
the  operating  room ;  at  the  same  time  any  false  teeth  are  removed. 

Just  before  the  operation  a  second  application  of  iodine  is  usually 
made,  but  many  surgeons  do  not  consider  this  necessary.  The 
iodine  is  applied  with  a  sterile  swab. 

In  emergency  operations  the  washing  is  omitted  and  the  shaving 
done  without  soap  because  the  iodine  penetrates  the  skin  better  if 
it  is  perfectly  dry. 

After-care:  While  the  operation  is  being  done  the  bed  has  been 
prepared  in  the  prescribed  manner;  when  the  patient  is  in  bed  a 
nurse  is  detailed  to  remain  by  him  until  the  effects  of  the  anesthetic 
have  passed  oif.  This  is  necessary  as  in  his  unconscious  condition 
he  may  fall  out  of  the  bed,  tear  oif  his  dressings,  get  up,  or  choke 
while  vomiting,  and  be  unable  to  help  himself.  Sometimes  the 
patient  may  be  in  a  condition  of  extreme  shock,  with  cold,  clammy 
skin,  shallow  breathing,  and  weak  rapid  pulse;  in  such  a  case  hot- 
water  bottles  should  be  freely  used,  stimulants  given,  and  the  foot 
of  the  bed  raised.  After  shock  the  next  dangers  to  be  looked  for 
are  hemorrhage  and  infection.  Infection  usually  first  manifests 
itself  by  a  rise  of  temperature  and  chilly  sensations;  even  aseptic 
cases,  however,  often  have  a  temperature  of  about  ioo°  F.  for  the 
first  day  or  two,  constituting  what  is  known  as  surgical  fever.  In 
aseptic  cases  there  is  little  for  the  nurse  to  do  beyond  the  adminis- 
tration of  diets,  as  the  first  dressings  are  not  changed  for  a  week  or 
ten  days.  The  urine  usually  has  to  be  drawn  every  six  hours  for 
the  first  twenty-four  hours,  or  until  the  control  of  the  bladder  is 
regained. 

In  surgical  rounds  the  duty  of  the  nurse  is  to  have  everything 
ready  for  any  necessary  change  of  dressings.  Dressings  may  be 
done  in  the  ward,  or  there  may  be  a  special  dressing  room  to  which 
the  patients  are  taken  on  a  litter.  In  the  former  case  a  movable 
dressing  table  or  ward  carriage  is  usually  employed.  Besides  a 
liberal  supply  of  sterilized  dressings  in  glass  jars  there  will  be 
required  bandages,  safety  pins,  an  irrigator,  antiseptic  and  sterile 
normal  saline  solutions,  scissors,  dressing  forceps,  dissecting  forceps, 


OPERATING  ROOM  AND  SURGICAL  NURSING    245 

basins,  and  a  covered  pail  or  paper  bags  for  the  soiled  dressings,  hot 
and  cold  water,  soap,  hand  brushes,  towels,  and  rubber  sheeting.' 

Dressings  are  of  two  general  types,  dry  dressings  and  wet  dress- 
ings; the  former  are  almost  invariably  used  in  aseptic  wounds  and 
consist  of  a  pad  of  sterile  gauze  about  half  an  inch  thick,  covered 
with  a  layer  of  absorbent  cotton.  IVet  dressings  are  used  in  infected 
wounds  and  consist  of  a  pad  of  sterile  gauze  soaked  in  a  i  :2ooo 
solution  of  corrosive  sublimate  or  a  two-per-cent  solution  of  phenol ; 
over  this  a  layer  of  absorbent  cotton,  and  then  a  piece  of  oil  silk, 
rubber  tissue,  or  waxed  paper.  Antiseptics  are  used  in  wet  dress- 
ings because  we  wish  to  destroy  the  germs  which  we  know  are 
already  present,  and  the  whole  dressing  is  covered  by  a  protective, 
as  we  call  the  oil  silk,  because  we  wish  to  keep  the  dressing  moist 
and  so  allow  a  more  uniform  diffusion  of  the  discharges  which 
always  occur  in  infected  wounds. 

The  operating  room:  The  attendant  in  charge  of  the  operating 
room  must  have  a  clear  understanding  of  the  technique  of  aseptic 
operating  and  must  be  a  man  of  great  carefulness  and  conscientious 
in  details.  He  must  remember  always  that  surgical  infections 
usually  come  from  contact  with  something  not  surgically,  clean,  and 
not  from  the  air.  The  room  itself  must  be  clean  and  free  from 
dust;  it  must  be  disinfected  at  frequent  intervals  and  no  dusting 
must  ever  be  permitted  there;  instead  the  floors  must  be  mopped 
and  the  walls  wiped  with  cloths  moistened  with  an  antiseptic  solu- 
tion. The  temperature  of  the  room  should  be  about  72°  F.,  80°  F. 
in  abdominal  operations. 

Sterilisers:  There  are  two  general  types  of  sterilizers  in  use,  the 
essential  difiference  being  that  in  one  steam  is  used  under  pressure, 
and  in  the  other  the  steam  is  flowing.  Of  the  latter  kind  of 
sterilizer,  the  Arnold  is  a  type.  In  hospitals,  steam  under  pressure 
is  always  used. 

The  steam  pressure  sterilizer  is  known  as  an  autoclave.  It  con- 
sists essentially  of  a  metal  cylinder  with  a  tight  fitting  door,  and  pro- 
vided with  a  steam  pressure  gauge,  safety  valve,  air  vent,  ther- 
mometer, and  apertures  for  the  entrance  of  steam. 

Outside  the  cylinder  is  a  steam  jacket,  with  a  space  between  it  and 
the  cylinder,  in  which  the  steam  circulates. 

In  sterilizing  dressings,  a  pressure  of  fifteen  pounds  of  steam  for 
twenty  minutes  is  usually  employed. 


246  NURSING 

If  glassware  is  used  in  the  sterilizer,  it  is  necessary  to  put  a  folded 
towel,  or  something  of  that  nature,  between  the  glass  and  the  metal, 
to  prevent  breakage,  and  if  liquids  are  contained  in  the  glass,  the 
door  of  the  chamber  should  not  be  opened  until  the  pressure  within 
is  reduced  to  the  normal,  otherwise  the  liquid  may  boil  over  or  the 
stopper  may  be  blown  out. 

The  operating  table  is  prepared  by  covering  it  with  a  folded  blan- 
ket, over  which  is  placed  a  rubber  sheet  and  over  that  a  sterilized 
sheet  or  a  Kelly  pad  or  surgical  cushion  may  be  used.  On  a  small 
table  by  the  head  of  the  operating  table  are  placed  the  appliances 
used  in  anesthesia. 

Instruments  are  usually  sterilized  by  boiling  from  two  to  five 
minutes  in  one-per-cent  solution  of  soda,  the  soda  being  used  to  pre- 
vent rusting.  As  boiling  dulls  sharp  instruments,  these  may  be 
better  sterilized  by  soaking  in  95  per  cent  alcohol  for  half  an  hour. 

Aluminum  instruments  are  ruined  by  soda  solution;  they  must 
be  boiled  in  plain  water. 

Instrument  trays,  basins  and  pitchers,  and  rubber  irrigators  are 
boiled  five  minutes  in  plain  water. 

Dressings  cut  in  proper  sizes,  bandages  and  gauze,  sponges,  tow- 
els, sheets,  and  operating  gowns  are  wrapped  in  towels  or  sheets, 
pinned  in  small  packages,  and  sterilized  twenty  minutes  under  fifteen 
pounds  steam  pressure.  Besides  the  dry  sterilized  towels  a  number 
of  damp  towels  sterilized  by  boiling  should  be  ready  to  surround 
the  field  of  operation  and  for  other  purposes. 

Gauze  sponges  are  prepared  of  four  or  five  thicknesses  of  gauze 
about  six  inches  square  with  the  end  sides  folded  in  or  stitched  so 
that  there  will  be  no  loose  threads  to  be  left  in  the  wound. 

Laparotomy  pads  are  usually  of  several  thicknesses,  with  the  edges 
turned  over  and  sewed,  and  with  a  tape  fastened  to  one  corner. 

Gauze  for  packing  is  cut  in  long  narrow  strips,  folded  inward  sev- 
eral times  from  the  edges,  and  the  strips  then  packed  in  glass  tubes 
closed  with  cotton,  before  being  sterilized. 

In  many  hospitals  gauze  which  has  been  used  except  in  septic 
cases  is  used  over  again  after  preparation  as  follows :  Soak  for 
several  hours  in  cold  water,  with  frequent  stirring.  Wash  clean, 
under  a  running  stream  of  tepid  water.  Boil  for  half  an  hour. 
Wring  out  dry,  and  then  proceed  as  with  new  gauze. 

Iodoform  gauze  is  frequently  used,  especially  for  packing  suppu- 


OPERATING  ROOM  AND  SURGICAL  NURSING    247 

rating  wounds  or  abscess  cavities ;  it  is  prepared  as  follows :  Sterilize 
five  yards  of  gauze ;  mix  ten  ounces  of  glycerin  with  an  equal  amount 
of  water  and  boil  fifteen  minutes;  add  a  half-ounce  of  iodoform  to 
three  ounces  of  alcohol  and  mix  with  the  water  and  glycerin ;  then 
while  stirring  briskly,  immerse  the  gauze  in  the  mixture ;  wring  out 
and  keep  moist  in  a  closed  glass  jar. 

The  sutures  and  ligatures  ordinarily  used  are  catgut,  silk,  silkworm 
gut,  and  silver  wire ;   the  three  last  named  are  sterilized  by  simple 


Fig.   217. —  Preparation   of  Gauze   Sponges. 

boiling  in  plain  water.  Catgut  is  not  made  from  the  gut  of  a  cat, 
but  from  that  of  the  sheep;  being  animal  in  nature  it  requires 
thorough  sterilization,  but  will  not  stand  boiling  in  water.  Catgut 
in  the  army  medical  service  is  usually  issued  already  sterilized,  but 
most  surgeons  prefer  not  to  rely  on  trade  processes,  and  prepare 
their  own  animal  sutures.  There  are  many  different  methods 
employed ;  nearly  all  include  as  the  first  step  the  removal  of  the  fat 
from  the  catgut  by  soaking  forty-eight  hours  in  ether  which  is 
changed  daily. 

Among  the  methods  are  boiling  in  alcohol,  the  iodine  method, 
and  the  cumol  method. 

The  iodine  method  is  satisfactory  and  simple.  The  catgut  without 
previous  preparation  is  wound  on  glass  spools  in  one  layer  and 
placed  in  a  one-per-cent  solution  of  iodine  and  iodide  of  potash  in 
distilled  water  for  one  week ;  the  spools  are  then  withdrawn  and  kept 
in  alcohol. 

Boiling  in  alcohol.  Wind  the  catgut  on  clean  glass  spools,  soak  in 
ether  for  twenty-four  hours  to  remove  grease,  shaking  several  times 
during  the  period;    remove  from  the  ether  and  soak  twenty- four 


248  NURSING 

hours  in  alcoholic  solution  of  corrosive  sublimate  1:500;  remove 
from  sublimate  solution  and  boil  in  95  per  cent  alcohol  over  a  water 
bath  for  ten  minutes.     Keep  in  same  jar  until  required  for  use. 

Metal  and  glass  syringes  with  rubber  or  asbestos  packing  may 
be  boiled;  if  the  packings  are  leather  draw  boiling  water  into  the 
syringe,  immediately  force  it  out,  wash  out  several  times  with  five 
per  cent  phenol,  and  soak  in  the  same  solution  while  full ;  the  needles 
are  boiled  with  the  wires  in  place. 

Rubber  goods:  Vulcanized  rubber  may  be  boiled  for  one  minute; 
fountain  and  bulb  syringes,  drainage  tubing,  rubber  bandages,  rub- 
ber gloves  and  finger  cots,  soft-rubber  catheters  and  bougies,  may  be 
boiled  five  minutes  in  plain  water. 

Hard  rubber  is  spoiled  by  boiling;  soak  in  five  per  cent  phenol. 
Rubber  tissue  (gutta-percha)  will  not  stand  boiling;  wash  in  cold 
water  with  green  soap,  rinse,  immerse  twenty-four  hours  in  solution 
of  corrosive  sublimate  i  :iooo. , 

Web  catheters  and  bougies  will  not  stand  heat;  disinfect  in  an 
antiseptic  solution. 

Large  quantities  of  boiled  water,  both  hot  and  cold,  will  be  neces- 
sary, also  sterile  normal  saline  solution,  and  freshly  prepared  antisep- 
tic solutions  —  two  per  cent  phenol  and  1:2000  bichloride  of 
mercury. 

Normal  saline  solution  is  a  0.9  per  cent  solution  of  sodium  chloride 
(common  salt)  in  water.  It  is  called  "normal"  because  it  has  the 
same  specific  gravity  as  blood  serum,  which  fact  renders  it  less  irri- 
tating than  plain  water.  It  is  prepared  by  dissolving  nine  grammes 
of  salt  in  a  liter  of  boiling  water  and  sterilizing  in  a  glass  flask,  which 
is  exposed  to  flowing  steam  in  a  steam  sterilizer  for  a  half-hour  at  a 
time  on  three  successive  days.  This  method  of  fractional  sterili- 
zation is  more  successful  than  a  single  sterilization  for  an  hour  and 
a  half  because,  while  a  single  exposure  of  half  an  hour  will  kill  all 
the  adult  bacteria,  the  spores  or  seeds  are  more  resistant ;  the  inter- 
vals of  twenty-four  hours  allow  the  development  of  the  spores 
which  are  then  killed  by  the  next  sterilization.  The  mouth  of  the 
flask  is  closed  with  nonabsorbent  cotton  which  is  drawn  over  the 
lip  of  the  flask  and  held  in  place  by  a  piece  of  gauze.  In  the  absence 
of  normal  saline  tablets  or  exact  means  of  measurement,  the  proper 
amount  of  salt  may  be  approximated  by  using  a  scant  teaspoonful 
to  a  pint  of  water.     In  emergency  the  water  is  simply  boiled  five 


OPERATING  ROOM  AND  SURGICAL  NURSING    249 

minutes  instead  of  being  subjected  to  fractional  sterilization.  When 
used  for  intravenous  or  subcutaneous  infusion  the  sokition  should 
be  filtered  just  before  use. 

Drainage  may  be  tubular  or  capillary ;  for  the  former,  rubber  or 
glass  drainage  tubes  are  employed.  Rubber  drains  are  prepared 
for  use  by  washing  with  soap  and  water,  rinsing,  boiling  five  min- 
utes, and  keeping  in  a  three-per-cent  solution  of  phenol  frequently 
changed.  Glass  drains  are  boiled.  For  capillary  drainage  we  use 
a  few  strands  of  catgut  or  horsehair,  or  the  so-called  "cigarette 
drain."  The  "  cigarette  drain "  is  prepared  by  rolling  a  strip  of 
gauze  of  the  proper  size  in  a  piece  of  gutta-percha  tissue,  just  as 
tobacco  is  rolled  in  a  paper  to  make  a  cigarette.  For  capillary 
drainage  we  use  strips  of  gauze  about  an  inch  wide  and  free  from 
any  loose  threads,  or  a  few  strands  of  silkworm  gut  may  be 
employed. 

The  most  important  part  of  the  whole  preparation  is  the  disin- 
fection of  the  hands  and  forearms  of  the  operator  and  his  assistants. 
Many  different  methods  have  been  recommended  for  this  purpose, 
and,  while  none  are  capable  of  making  the  hands  germ  free,  most 
of  them  give  satisfactory  results.  In  all  the  methods  there  are  two 
steps:  first,  mechanical  cleaning;  second,  chemical  sterilization ;  the 
first  is  by  far  the  most  important. 

An  excellent  method  of  mechanical  cleansing  is  as  follows :  After 
trimming  the  nails  close  remove  all  dirt  from  beneath  them  with  a 
nail  cleaner;  anoint  the  hands  with  soft  soap  or  a  liniment  of  soft 
soap,  and  rub  thoroughly  with  a  mixture  of  equal  parts  of  corn-meal 
and  powdered  mustard ;  wash  in  running  hot  water  and  thoroughly 
scrub  for  five  minutes  with  a  stiff  brush  recently  boiled ;  pay  especial 
attention  to  the  edges  of  the  nails ;  again  clean  the  nails  with  a  sterile 
cleaner,  rinse  the  hands  in  boiled  water,  immerse  in  alcohol,  and 
scrub  five  minutes,  using  gauze  sponges. 

Most  surgeons  prefer  to  use  freshly  boiled  rubber  gloves,  but  even 
with  the  gloves  sterilization  must  be  done  just  as  thoroughly,  as 
gloves  are  often  punctured  or  leaky. 

The  field  of  operation  is  prepared  by  painting  it  with  tincture  of 
iodine ;  only  so  much  of  the  surface  as  is  necessary  is  exposed,  all  the 
rest  of  the  body  being  protected  by  a  blanket  covered  with  sterile 
sheets;  immediately  around  the  operating  field  wet  antiseptic  or 
sterile  towels  are  used. 


2B6  Nursing 

The  sterilization  of  the  hands  is  usually  done  after  the  operating 
gowns  or  suits  are  put  on,  and  once  done  nothing  should  be  touched 
which  is  not  sterile ;  this  is  the  rule  which  is  most  frequently  broken 
by  the  inexperienced  nurse ;  in  his  hurry  or  excitement  he  picks  up 
something  which  is  not  sterile  and  then  he  must  disinfect  fiis  hands 
again. 

Frequently  during  the  operation  the  surgeon  will  wish  to  wash 
his  hands  to  remove  blood,  so  that  a  basin  of  sterile  water  must  be 
kept  ready  at  hand. 

After  the  operation  the  room  must  be  immediately  cleaned.  All 
unused  animal  sutures  which  have  been  handled  should  be  thrown 
away;  soiled  or  bloody  towels,  sheets,  etc.,  placed  to  soak  in  cold 
water  and  the  instruments  cleaned,  counted,  and  put  away. 

To  clean  the  instruments  they  are  taken  apart  and  washed  in  cold 
water  to  remove  the  blood,  paying  special  attention  to  serrated  parts, 
they  are  then  washed  in  hot  water  and  soft  soap,  rinsed,  and  thor- 
oughly dried.  Instruments  which  have  been  used  in  an  infectious 
case  must  be  sterilized  before  being  cleaned.  Scalpels  and  other 
cutting  instruments  must  be  cleaned  separately,  taking  particular 
care  not  to  dull  the  cutting  edge.  Needles  should  be  dipped  in 
alcohol,  thoroughly  dried,  and  placed  in  a  box  with  lycopodium. 

Artery  forceps  which  take  apart  usually  have  the  same  number 
stamped  on  the  corresponding  blades;  if  they  do  not,  they  should 
be  cleaned  one  by  one,  so  as  not  to  get  them  mixed.  Locks,  screws, 
holes,  and  depressions  must  be  carefully  cleaned  and  dried  with 
wisps  of  absorbent  cotton. 

Rouge  and  putz-pomade  may  be  used  to  remove  rust  and  stain. 

The  leather  packing  and  washers  of  syringes  must  be  kept  moist 
by  frequent  use  of  water  or  glycerin,  and  such  syringes  should 
always  be  tested  before  use  to  see  that  they  are  in  working  order. 

Fountain  syringes  after  washing  should  be  hung  bottom  up  to  dry, 
after  which  their  mouths  should  be  plugged  with  cotton  to  exclude 
dust. 

Rubber  catheters  after  drying  are  to  be  kept  in  talcum. 

Rubber  bandages  in  like  manner  are  to  be  dusted  with  talcum 
and  rolled  up,  tapes,  if  any,  inside;  they  must  be  protected  from 
the  air  by  inclosure  in  a  tin  box  with  the  top  secured  with  a  strip  of 
rubber  plaster. 

Rubber  gloves  should  be  thoroughly  dried  with  a  towel,  dusted 


OPERATING  ROOM  AND  SURGICAL  NURSING    251 

with  talcum  inside  and  out,  and  protected  from  the  air  in  tin  boxes. 
Punctures  may  be  closed  with  rubber  cement,  or  patched  with  a 
piece  of  an  old  glove  by  the  aid  of  the  cement. 

In  the  field  many  of  the  conveniences  of  the  operating  room  in 
the  post  hospital  are  absent,  yet  very  excellent  results  may  be  ob- 
tained. The  work  must  be  done  in  a  tent,  or  even  with  no  more 
shelter  than  a  fly ;  under  such  circumstances  dust  is  one  of  the  great- 
est dangers  to  be  guarded  against.  If  possible  no  movement  of 
troops  or  wagons  should  be  allowed  in  the  immediate  vicinity ;  the 
floor  of  the  tent  and  the  grounds  around  it  should  be  thoroughly 
sprinkled  to  lay  the  dust,  and  wet  sheets  may  be  hung  up  so  as  to 
afford  further  protection  to  the  wounds.  If  no  soda  is  available 
to  boil  the  instruments,  wood  ashes  may  be  used  tied  up  in  a  bag 
to  avoid  clouding  the  water;  when  steam  sterilizers  cannot  be  had 
the  dressings  may  be  boiled,  or,  in  the  absence  of  fire,  saturated 
with  antiseptics.  When  the  water  is  very  hard,  muddy,  or  full  of 
organic  matter,  bichloride  of  mercury  is  so  rapidly  decomposed 
that  it  should  not  be  relied  upon  as  an  antiseptic;  phenol  should  be 
used  instead.  If  there  are  no  receptacles  large  enough  to  boil 
the  trays  they  should  be  scalded  with  boiling  water,  and  strong 
antiseptic  solutions  allowed  to  stand  in  them  for  a  half-hour  before 
use. 

In  the  absence  of  other  suture  material  horsehair  answers  very 
well;  it  may  be  rendered  aseptic  by  washing  with  soft  soap  and 
water,  boiling  ten  minutes  in  0.25  per  cent  solution  of  soda  and  then 
ten  minutes  more  in  plain  water,  after  which  it  is  kept  in  a  i  :iooo 
alcoholic  solution  of  corrosive  sublimate. 


CHAPTER  XIII 

NURSING   IN   THE    INFECTIOUS   DISEASES 

It  is  important  that  nurses  should  know  something  of  the  most 
common  infectious  diseases,  especially  how  they  are  transmitted 
from  person  to  person,  the  particular  symptoms  and  special  dangers 
of  each,  and  how  they  affect  the  character  of  the  nursing. 

We  have  already  defined  infectious  diseases  as  those  which  may 
be  transmitted  to  others;  it  is  the  business  of  the  nurse  to  prevent 
such  transmission. 

It  should  be  remembered  that  contact  is  the  great  source  of  in- 
fection in  medical  cases,  just  as  it  is  in  surgical  cases,  and  therefore 
medical  asepsis  should  be  observed. 

All  utensils  and  appliances  used  about  the  patient  should  be  for 
his  exclusive  use,  and  kept  within  the  room  or  barrier;  nothing 
should  be  taken  out  of  the  room  unless  it  be  immediately  sterilized ; 
the  nurse  should  wear  rubber  gloves  when  handling  the  patient,  or 
wash  and  sterilize  his  hands  immediately  thereafter,  and  should  put 
on  a  special  gown,  to  be  kept  in  the  room,  whenever  he  comes  in 
contact  with  the  patient  or  his  bed. 

Vaccines  and  antitoxins.  Vaccines  usually  contain  the  dead  or 
weakened  germs  of  the  disease  against  which  they  are  used,  while 
serums  and  antitoxins  contain  the  natural  antidotes  for  the  poison 
created  by  their  germs.  Both  vaccines  and  antitoxins  are  used  as 
well  to  cure  diseases  as  to  prevent  them. 

The  most  common  vaccines  are  those  of  smallpox,  typhoid,  cholera, 
and  plague,  while  the  most  common  antitoxins  are  those  of  diph- 
theria, tetanus,  and  plague. 

Vaccination  against  typhoid.  The  site  of  the  inoculation  is  the 
arm  at  the  insertion  of  the  deltoid  muscle.  If  for  any  reason  this 
site  can  not  be  used,  the  needle  may  be  introduced  in  the  back,  over 
the  lower  portion  of  the  scapula,  or  in  the  chest  below  the  clavicle. 
The  dose  is  to  be  given  subcutaneously  and  not  into  the  muscles  nor 
into  the  skin.    The  arm  should  be  cleansed  as  for  any  other  operation. 

(252) 


INFECTIOUS  DISEASES  253 

Tincture  of  iodine  painted  over  the  dry  skin,  before  and  after  the 
injection,  has  proven  satisfactory. 

The  ampule  should  be  washed  off  in  an  antiseptic  solution  and 
opened  after  making  one  or  more  cuts  near  the  top  with  a  file. 
The  vaccine  can  be  drawn  out  of  the  container  with  a  syringe,  or 
it  may  be  emptied  into  a  shallow  glass  dish,  such  as  a  salt  cellar, 
which  has  been  sterilized  by  boiling. 

The  syringe  and  needle  should  be  sterilized  by  boiling  in  two-per- 
cent soda  solution.  To  insure  perfect  sterilization,  draw  the  piston 
out  to  its  full  length,  or  remove  it  entirely,  so  that  the  barrel  is  full 
of  water  during  the  boiling.  A  fresh  needle  should  be  used  for  each 
man,  or,  if  one  needle  must  be  used  on  two  or  more  men,  it  should 
be  resterilized  before  each  injection. 

Among  the  more  common  infectious  diseases  are  gonorrhea,  chan- 
croid, syphilis,  typhoid  fever,  malaria,  yellow  fever,  cerebro-spinal 
fever,  dysentery,  cholera,  diphtheria,  tuberculosis,  influenza,  ton- 
sillitis,  mumps,  erysipelas,  and  wound  infections. 

Typhoid  fever:  This  disease  is  due  to  infection  with  the  typhoid 
bacillus,  which  always  gains  entrance  to  the  body  through  the  mouth, 
and  escapes  from  the  body  of  the  typhoid  patient  in  the  stools  and 
urine  and  occasionally  in  the  sputum.  The  germs  are  usually 
swallowed  in  infected  water  or  food,  but  may  get  into  the  mouth 
indirectly  as  when  one  has  been  handling  infected  clothes,  bedding, 
or  other  articles,  and  then  handles  food  without  washing  the  hands. 
The  urine  of  the  typhoid  patient  often  contains  typhoid  germs  for 
weeks  after  the  patient  is  convalescent,  hence  the  danger  of  urinating 
on  the  ground,  where  the  germs  grow  readily  and,  getting  on  the 
shoes  of  the  soldier,  are  carried  into  barracks. 

The  initial  lesion  of  typhoid  fever  is  usually  ulceration  of  the 
lower  end  of  the  small  intestine,  and  this  ulceration  causes  diarrhea 
and  may  go  deep  enough  to  cause  hemorrhage  or  even  perforation 
of  the  bowel.  Sudden  collapse  in  the  course  of  typhoid  fever  is 
usually  caused  by  either  perforation  or  hemorrhage. 

The  fever  ordinarily  lasts  about  four  weeks. 

For  his  own  protection  the  nurse  should  submit  himself  to  pro- 
phylactic vaccination  against  typhoid  and  in  addition  must  be  care- 
ful to  thoroughly  wash  and  disinfect  his  hands  every  time  after 
handling  his  patient,  and  again  before  eating.  For  the  protection  of 
others  he  must  disinfect  immediately  all  urine  and  stools,  and  every- 


-254  NURSING 

thing  which  may  have  been  soiled  by  them,  such  as  bedding,  towels, 
nightclothes,  etc.  Even  the  water  which  has  been  used  in  bathing 
the  patient  must  be  regarded  as  infected ;  it  should  never  be  emptied 
on  the  ground,  but  into  a  sink  which  is  afterward  flushed  with  a 
disinfectant  solution. 

Separate  thermometers,  feeding  cups,  etc.,  must  always  be  used, 
but  if  this  is  not  practicable  they  must  be  disinfected  before  use 
with  other  patients. 

As  flies  carry  the  disease  germs  on  their  feet  they  must  not  be 
allowed  to  reach  the  patient  or  his  discharges.  Clothing  and  bedding 
must  be  disinfected. 

Dysentery:  This  occurs  in  two  principal  forms,  amebic  or  tropical 
dysentery,  and  bacillary  or  epidemic  dysentery.  In  both  forms  the 
germs  are  swallowed  with  water  or  food,  chiefly  the  former,  and  in 
both  they  are  thrown  off  in  the  stools. 

The  disease  is  therefore  spread  much  like  typhoid  fever,  and  the 
precautions  to  be  taken  are  practically  the  same,  except  that  the 
urine  in  dysentery  is  not  infectious. 

Cholera:  This  disease  is  spread  in  the  same  way  as  dysentery, 
but  is  of  short  duration  and  very  fatal.  The  only  safety  lies  in 
eating  and  drinking  nothing  which  has  not  been  recently  cooked. 

Clothing  and  bedding  must  be  disinfected,  and  also  of  course  the 
stools  and  vomited  matter. 

Malaria:  In  this  disease  the  infection  is  in  the  blood  and  cannot 
be  carried  from  one  person  to  another  except  by  mosquitoes  (the 
anophelina),  which,  after  biting  the  malarial  patient,  then  bite  a 
person  hitherto  well.  Therefore,  the  sick  must  be  protected  against 
mosquitoes,  so  that  the  mosquitoes  can  not  get  the 'disease,  and  the 
well  must  be  also  protected,  so  that  if  there  are  any  infected  mos- 
quitoes about  they  may  not  do  any  harm. 

Yellozv  fever:  This  disease  resembles  malaria  in  that  the  infection 
is  in  the  blood,  and  can  only  be  carried  by  the  mosquito  (Aedes 
calopiis)  ;  the  precautions  to  be  taken  are  the  same.  It  is,  however, 
a  much  more  serious  malady  than  malaria,  and  usually  of  much 
shorter  duration.  A  curious  feature  of  the  disease  is  that  it  is  not 
infectious,  that  is,  cannot  infect  the  mosquito,  after  the  end  of  the 
third  day;  but  the  mosquito  once  infected  is  capable  of  carrying 
the  disease  to  man  probably  as  long  as  she  (the  mosquito)  lives. 

Cerebrospinal  meningitis:   In  this  disease  it  is  believed  that  the 


INFECTIOUS  DISEASES  255 

infective  germ  usually  gains  access  to  the  body  through  the  throat  and 
nose  and  is  frequently  received  from  meningococcus  carriers,  or 
persons  who  have  been  in  contact  with  other  cases  or  themselves 
recently  had  the  disease  and  still  carry  the  coccus  in  their  throats. 
This  being  the  case,  it  is  necessary  to  carefully  disinfect  all  discharges 
from  the  throat  and  nose  of  the  patient  and  also  that  nurses  and 
physicians  who  come  in  contact  with  cases  of  this  disease  should 
frequently  spray  their  own  throats  and  noses  with  an  antiseptic 
solution.  Inasmuch  as  we  do  not  know  just  how  contagious  the 
disease  is,  nor  in  what  excretions  the  meningococcus  leave  the  bodies 
of  the  sick,  all  cases  and  their  attendants  must  be  carefully  isolated, 
and  all  discharges  from  the  patient  and  everything  which  has  come 
in  contact  with  him,  including  the  room  in  which  treated  and  its 
contents,  must  be  thoroughly  disinfected. 

Gonorrhea  or  clap:  There  is  no  danger  of  contracting  this  disease 
in  its  ordinary  form  except  through  sexual  intercourse,  but  there 
is  danger  of  getting  some  of  the  pus  into  the  eyes  and  thereby  induc- 
ing a  very  serious  inflammation  which  ofter  completely  destroys 
vision.  This  may  happen  to  the  patient  himself  by  bringing  the 
unwashed  hands,  after  handling  the  penis,  in  contact  with  the  eyes, 
or  more  commonly  to  the  nurse  or  other  innocent  person,  from  use 
of  a  towel  on  which  the  gonorrhea  patient  has  managed  to  get  some 
of  the  pus  from  his  penis.  Such  a  patient  should  be  cautioned 
about  the  danger  to  his  own  eyes,  and  should  not  be  allowed  to  use 
any  toilet  article  except  his  own. 

Chancroid:  While  this  disease  is  nearly  always  venereal,  a  nurse 
with  a  hang-nail  or  other  abrasion  may  inoculate  himself  while 
dressing  the  sore  or  the  resulting  bubo. 

Syphilis:  Syphilis,  though  very  contagious  at  certain  times  and 
under  certain  conditions,  is  not  always  so.  The  chancre,  mucous 
patches,  condylomata,  and  the  blood  during  the  first  few  years  of 
the  disease,  are  all  contagious.  The  mucous  patches,  being  often 
located  in  the  mouth  and  throat  where  they  are  not  visible,  are  espe- 
cially dangerous.  All  the  table  ware,  toilet  articles,  instruments  and 
appliances,  and  bed  linen  used  by  syphilitics  should  be  kept  entirely 
separate  from  those  used  by  others,  and  should  be  frequently  disin- 
fected. Should  the  nurse  have  any  cut  or  abrasion  on  his  hands 
he  must  be  exceedingly  careful  in  handling  the  syphilitic  lesions, 
or  the  dressings  which  have  been  used  on  them. 


256  NURSING 

Pulmonary  tuberculosis:  In  this  disease  the  infection  is  contained 
in  the  sputum.  As  long  as  the  sputum  is  moist  the  germs  can  not 
escape  into  the  air,  but  they  may  be  carried  by  flies  which  alight  upon 
it  or  in  the  fine  spray  which  is  thrown  out  when  the  patient  coughs. 
The  danger  is  in  the  dry  sputum  which  becomes  pulverized  and 
mixed  with  dust ;  hence  it  must  be  kept  moist  and  always  received 
in  a  disinfectant  solution.  If  paper  spit  cups  are  used,  these  with 
their  contents  are  burned.  Clothing  and  bedding  must  be  dis- 
infected. 

Pneumonia,  like  tuberculosis,  is  infectious  through  sputum  which 
must  be  treated  in  the  same  way  as  that  of  the  latter  disease.  Cloth- 
ing and  bedding  must  be  disinfected. 

Influenca;  or  "  the  Grip  "  :  In  this  disease  the  sputum  is  infectious 
and  also  the  nasal  discharge  when  there  is  any.  The  sputum  is  to 
be  treated  like  that  of  pneumonia  and  tuberculosis,  the  nasal  dis- 
charges are  to  be  received  on  small  pieces  of  gauze  or  toilet  paper 
and  immediately  burned.    Clothing  and  bedding  must  be  disinfected. 

In  follicular  tonsillitis  the  discharges  from  the  nose  and  throat 
are  infectious  and  should  behandled  in  the  same  way  as  those  of 
influenza. 

The  same  remark  applies  to  diphtheria,  but  this  disease  is  very 
contagious  through  particles  of  the  membrane  which  is  present  in 
the  throat  and  often  in  the  nose,  and  may  be  coughed  into  the  face 
of  the  attendant;  minute  portions  of  the  membrane  lodged  in  the 
eye,  nose,  or  mouth  of  the  attendant  may  reproduce  the  disease  in 
him.  Patients  with  diphtheria  should  always  be  isolated.  Clothing 
and  bedding  must  be  disinfected. 

Measles  belongs  to  the  class  of  eruptive  fevers,  which  includes 
also  scarlet  fever,  smallpox,  and  chicken  pox,  all  of  which  are  con- 
tagious, the  infectious  agent  being  inhaled  or  swallowed.  Though 
there  is  reason  to  believe  that  they  are  all  germ  diseases,  that  sup- 
position has  not  been  proven  for  any  of  them.  The  discharges  from 
the  throat  and  nose  are  highly  infections,  as  are  also  the  skin  lesions 
in  smallpox.  The  modern  belief  is  that  this  class  of  diseases,  like 
erysipelas  and  other  wound  infections,  is  spread  chiefly  if  not  en- 
tirely by  persons  or  things  which  have  been  in  contact  with  other 
cases.  The  general  rules  for  nursing  infectious  diseases  are  to  be 
followed  and  all  discharges  disinfected.     Before  the  convalescent 


INFECTIOUS  DISEASES  257 

is  allowed  to  mix  with  well  people  he  should  be  given  an  antiseptic 
bath,  1 :2000  bichloride,  and  the  hair  and  scalp  thoroughly  shampooed. 

Mumps:  In  mumps  the  contagious  agent  is  probably  in  the  secre- 
tions of  the  mouth  and  throat.  The  disease  is  to  be  handled  like 
eruptive  fevers. 

Erysipelas  may  be  carried  from  one  wound  to  another  on  the 
hands  of  the  nurse,  on  instruments,  dressings,  etc.,  and  possibly 
also  through  the  air.  So  very  contagious  is  it  that  an  erysipelas 
patient  should  be  isolated  and  his  nurse  should  not  go  near  any 
one  with  a  wound. 

Wound  infections  are  readily  carried  from  one  patient  to  another 
in  the  same  way  as  erysipelas  is  transmitted.  A  nurse  who  dresses 
infected  wounds  should  not  attend  those  whose  wounds  are  aseptic. 

As  hospital  corps  men  serving  in  the  tropics  occasionally  have 
to  nurse  cases  of  plague,  it  is  necessary  that  they  should  know  some- 
thing of  that  disease. 

The  most  prominent  symptoms  of  plague  are  great  prostration, 
high  fever,  and  the  development  of  buboes,  most  commonly  in  the 
groin;  but  buboes  are  not  always  present.  The  disease  is  due  to  a 
bacillus  which  is  found  in  the  blood  and  all  the  discharges,  including 
the  pus  from  the  buboes,  the  urine,  feces,  sputum,  etc.  It  is  con- 
tagious and  everything  about  the  patient  becomes  infected,  especially 
the  locality.  It  may  be  conveyed  by  dust,  food,  water  and  clothing, 
by  rats,  mice  and  flies,  and  probably  by  ants  and  mosquitoes.  Often 
the  infection  occurs  through  some  slight  wound  of  the  skin.  Plague 
patients  should  be  isolated  and  everything  which  comes  in  contact 
with  them  disinfected.  Rats  and  vermin  of  every  sort  must  be 
systematically  destroyed,  and  the  utmost  cleanliness  insisted  upon. 
No  one  with  a  wound,  sore,  or  even  a  scratch,  should  nurse  plague 
patients  or  visit  an  infected  locality.  Nurses  should  wear  leggins 
and  should  frequently  disinfect  their  hands,  mouths,  and  nostrils. 

In  typhus  fever  the  infection  is  conveyed  by  the  bite  of  the  body 
louse ;  probably  also  by  the  head  louse  and  "  crab  "  louse. 

The  body  and  clothing  of  the  patient  must  be  thoroughly  disin- 
fected in  such  a  way  as  to  kill  all  lice  and  their  eggs ;  then  there  will 
be  no  danger  of  coatching  the  disease  provided  the  surroundings  of 
the  patient  are  also  clean  and  free  from  vermin. 
17 


PART  V 

MESS    MANAGEMENT    AND    COOKING 


CHAPTER   I 

MESS    MANAGEMENT 

The  management  of  the  hospital  mess  is  one  of  the  most  impor- 
tant duties  pertaining  to  the  hospital  corps,  as  upon  its  success  de- 
pends not  only  the  welfare  of  the  patients,  but  much  of  the  content- 
ment and  happiness  of  the  men  themselves.  The  noncommissioned 
officer  selected  for  this  assignment  must  be  not  only  a  man  of  in- 
telligence and  business  capacity,  but  also  one  who  has  had  actual 
experience  in  the  kitchen. 

The  sources  from  which  the  mess  is  supplied  are  the  rations  issued 
for  the  hospital  corps ;  a  variable  money  allowance  per  day  for  each 
enlisted  man  sick  in  hospital ;  the  hospital  fund ;  the  products  of  the 
hospital  garden,  chickens,  and  cows,  and,  in  the  field,  hospital  stores. 

A  ration  is  the  allowance  for  the  subsistence  of  one  person  for  one 
day.  The  garrison  ration  is  intended  for  troops  in  garrison,  and,  in 
time  of  peace,  for  troops  in  maneuver  camps ;  the  ration  to  be  issued 
to  troops  on  the  march  in  time  of  peace  will  be  prescribed  by  the 
commander,  and  will  not  exceed  the  allowances  prescribed  for  the 
garrison  ration :  the  travel  ration  is  for  troops  traveling  otherwise 
than  by  marching  and  separated  from  cooking  facilities ;  the  reserve 
ration  is  carried  on  the  person  of  the  men  and  in  the  trains,  and  con- 
stitutes the  reserve  for  field  service ;  the  field  ration  is  the  ration 
prescribed  in  orders  by  the  commander  of  the  field  forces;  the 
Filipino  ration  is  for  use  of  the  Philippine  Scouts;  and  the  emer- 
gency ration  for  troops  in  active  compangn  for  use  on  occasions  of 
emergency  or  in  the  field  for  purposes  of  instruction. 

In  time  of  war  when  Philippine  Scouts  are  serving  in  the  field 
they  will  be  subsisted  the  same  as  are  regular  troops.  When  im- 
practicable for  Philippine  Scouts  to  use  the  Filipino  ration  while 
traveling  otherwise  than  by  marching,  on  account  of  the  lack  of 
cooking  facilities  or  for  other  reasons,  the  travel  ration  may  be 
prescribed. 

The  kinds  and  quantities  of  the  component  articles  of  the  Army 

(259) 


260 


MESS  MANAGEMENT  AND  COOKING 


ration   and   the  substitutive  equivalent  articles    which  may  be 
issued  in  place  of  such  components  are  as  follows : 

I.  Garrison  Ration. 


Component    article*    and 
quantities. 


Beef,  fresh 


Flour 


Baking  powder 
Beans  


PotatoesS 


prunes 


Coffee,  roasted  and 

ground. 

Sugar  

Milk,      cvaporaled 

unsweetened. 
Vinegar 


Salt 

Pepper,  black 


Cinnamon    0.014 


0.08  ounces. 
2.4  ounces  . 


20  ounces 


1 .28  ounces 


1 .  12  ounces 


3 . 2  ounces. 
0..';  ounce. 


0.1 6  gill 


0.64  ounce. 
0.04  ounce. 


Lard 0 .  64  ounce. 

Butter 0.5  ounce  .. 

Sirup 0.32  gill. 

Flavoring    extract,  0.014  ounce 
lemon. 


Substitutive  articles  and  quantities. 


Mutton,  fresh   

Baconi 

Canned  meat,   when  impracticable  to  fur- 
nish fresh  meat. 

Hash,  corned  beef,   when  impracticable  to 
furnish  fresh  meat. 

Fish,  dried 

Fish,  pickled   

Fish,  canned    .•  :  •  • 

Turkey,   dressed,   drawn,   on  Thanksgiving 

Day  and  Christmas,  when  practicable. 
'  Soft  bread   

Hard    bread,    to    be    ordered    issued    only 
when    the   interests    of   the    Government 
so  require. 
[  Cornmeal    


20  ounces. 
12  ounces. 
16  ounces. 

16  ounces. 

14  ounces. 
18  ounces. 
16  ounces. 
16  ounces. 

18  ounces. 
i5  ounces. 


I  Rice   

I  Hominy 

Potatoes,   canned . 

Onions,  in  lieu  of  an  equal  quantity  of 
potatoes,  but  not  exceeding  twenty  per 
cent  of  total  issue. 

Tomatoes,  canned,  in  lieu  of  an  equal 
qvantity  of  potatoes,  but  not  exceeding 
twenty  per  cent  of  total  issue. 

Other  fresh  vegetables  (not  canned)  when 
they  can  be  obtained  in  the  vicinity  or 
transported  in  a  wholesome  condition 
from  a  distance,  in  lieu  of  an  equa 
quantity  of  potatoes,  but  not  exceedinj 
thirty  per  cent  of  total  issue. 
"Apples,  dried  or  evaporated 

Peaches,   dried  or  evaporated 

Jam,  in  lieu  of  an  equal  quantity  of 
prunes,  but  not  exceeding  fifty  per  cent 
of  total  issue. 

Coffee,  roasted,  not  ground 

Coffee,  green 

,  Tea,  black  or  green 


Pickles,  cucumber,  in  lieu  of  an  equal  quan 
tity  of  vinegar,  but  not  exceeding  fifty 
per  cent  of  total  issue. 


20  ounces. 

1 .6  ounces. 
1.6  ounces. 
IS  ounces. 


1 .28  ounces. 
1 .28  ounces. 


1 .  12  ounces. 
1 .4  ounces. 
0.32  ounce. 


rCloves   0.014  ounce. 

■<  Ginger   0.014  ounce. 

[Nutmeg jo. 014  ounce. 

Oleomargarine    

Vanilla  


o.s  ounce. 
0.014  ounce. 


'  In  Alaska,  16  ounces  bacon,  or,  when  desired,  16  ounces  salt  pork,  or  22  ounces  salt 
beef.  ■     « 

'  In  Alaska  the  allowance  of  fresh  vegetables  will  be  24  ounces  instead  of  20  ounces,  or 
canned  potatoes,  :8  ounces  instead  of   15   ounces. 

Note. —  Food  for  troops  traveling  on  United  States  Army  transports  will  be  prepared 
from  the  articles  of  subsistence  stores  which  compose  the  ration  for  troops  in  garrison, 
varied  by  the  substitution  of  other  articles  of  authorized  subsistence  stores,  the  total  daily 
cost  per  man  of  the  food  consumed  not  to  exceed  20  per  cent  more  thart  the  current  cost 
of  the  garrison  ration,  except  on  Thanksgiving  Day  and  Christmas,  when  60  per  cent 
increase  over  the  same  current  cost  is  authorized. 


MESS  MANAGEMENT 


261 


^  One  day  in  each  alternate  month  of  the  season  of  practical  instruc- 
tion, not  exceeding  three  days  in  each  year,  the  use  of  the  reserve 
ration  with  individual  cooking  will  be  required  by  all  troops  in  the 
field  for  purposes  of  instruction. 


2.  Travel  Ration, 

Component   articles    and 
quantities. 

Substitutive   articles  and  quantities. 

Soft  bread 

i8  ounces  . . . . 

Hard  bread   

Beef,  corned 

12  ounces  . . . . 
4  ounces. 
8  ounces. 
1 .4  ounces. 
1. 12  ounces. 

2.4   ounces. 
0.5  ounce. 

Hash,  corned  beef 

Beans,  baked    .... 
romatoes,  canned. 

Coffee,  roasted  and 
ground. 

Milk,     evaporated, 
unsweetened. 

3.  Reserve  Ration. 


Component    articles   and 
quantities. 


Substitutive  articles  and  quantities. 


Bacon 

or  meat  canned. 

Hard  bread 

Coffee,  roasted  and 

ground. 

Sugar  

Salt 


12  ounces. 
1 6  ounces. 
i6  ounces. 
1. 1 2  ounces. 

2.4  ounces, 
o.  i6  ounce. 


4.  Field  Ration. 
The  field  ration  is  the  ration  prescribed  in  orders  by  the  commander  of  the  field  forces. 
It  consists  of  the  reserve  ration  in  whole  or  in  part,  supplemented  by  articles  of  food 
requisitioned  or  purchased  locally,  or  shipped  from  the  rear,  provided  such  supplements 
or  substitutes  correspond  generally  with  the  component  articles  or  substitutive  equivalents 
of  the  garrison  ration. 

S.  Filipino  Ration. 


Component    articles    and 
quantities. 


Substitutive  articles  and  quantities. 


Beef,  fresh 


Flour   

Baking  powder, 
when  in  field 
and  ovens  are 
not  available. 

Rice,  unpolished. . 

Potatoes 

Coffee,  roasted  and 
ground. 

Sugar  

Vinegar  

Salt 

Pepper,  black  .... 


12  ounces 


8  ounces 


0.32  ounce. 


20  ounces. 
8  ounces  . . 

1  ounce. 

2  ounces. 
0.08  gill. 
0.64  ounce. 
0.02  ounce. 


f  Bacon    

I  Canned  meat 
1  Fish,   canned 
I  Fish,  fresh   . 
(  Hard  bread 
I  Soft  bread   . 


Onions 


8  ounces. 
8  ounces. 
12  ounces. 
12  ounces. 
8  ounces. 
8  ounces. 


8  ounces. 


262  MESS  MANAGEMENT  AND  COOKING 

Scout  organizations  will  be  required  to  use  the  entire  allowance 
of  the  meat  component,  and  not  more  than  i6  ounces  of  rice  per  day 
to  be  used  for  each  ration.  The  purchase  of  1.6  ounces  of  beans 
per  ration  in  substitution  of  the  portion  of  the  rice  ration  not  drawn 
will  be  made,  and  use  of  as  large  an  extent  as  possible  of  native 
products,  such  as  camotes,  mongos,  and  squash,  will  be  required. 

6.    EMERGENCY   RATION 

The  emergency  ration  is  furnished,  in  addition  to  the  regular 
ration,  as  required  for  troops  on  active  campaign  or  in  the  field  for 
purposes  of  instruction,  and  will  not  be  opened  except  by  order  of  an 
officer  or  in  extremity,  nor  used  when  regular  rations  are  obtainable. 

Ration  returns  upon  which  emergency  rations  are  drawn  will  bear 
the  certificate  of  the  organization  commander  that  such  rations  are 
required  for  the  enlisted  men  of  his  organization  and  that  the  money 
value  of  any  rations  previously  drawn  by  him,  and  improperly 
opened  or  lost,  has  been  charged  against  the  person  responsible. 

All  articles  of  the  garrison,  travel,  or  Filipino  ration  due  a  com- 
pany, or  other  military  organization,  will  be  retained  by  the  com- 
missary and  credit  given  to  the  organization  for  the  money  value  of 
these  articles  at  the  current  price  of  the  articles ;  and  the  commissary 
will  pay  as  savings  to  the  organization  commanders  any  excess  in 
value  of  the  stores  so  retained  over  those  purchased  by  the  organiza- 
tion. 

The  revenue  from  this  source  as  well  as  that  from  the  post  bakery 
(savings  on  flour),  the  post  exchange,  and  the  care  of  patients  other 
than  soldiers  in  hospital  constitutes  the  hospital  fund,  which  may  be 
expended  as  far  as  desirable  in  giving  greater  variety  and  abundance 
to  the  mess  of  the  hospital  corps. 

Variety  in  the  mess  is  of  much  importance  and  may  be  obtained 
through  the  use  of  the  alternative  issues,  by  purchases  from  the 
hospital  fund,  and  especially  by  variety  in  cooking.  Usually  bills  of 
fare  are  prepared  by  the  non  commissioned  officer  in  charge  of  the 
mess  and  submitted  to  the  surgeon  for  his  approval,  and  variety 
should  be  insisted  on.  It  is  the  duty  of  the  noncommissioned  officer 
also  to  see  that  the  meals  are  properly  and  promptly  served  in  both 
the  dining-room  and  wards. 

Wastage  must  be  carefully  avoided,  grease  and  drippings  should 
be  preserved  for  use  in  cooking,  and  bones  for  the  preparation  of 


MESS  MANAGEMENT  263 

soup.  In  the  dining-room  the  rule  should  be  small  portions  served 
as  desired  rather  than  large  portions  to  be  left  on  the  plate. 

Different  classes  of  diet  are  necessary  in  hospital  because  of  the 
great  variety  in  the  nature  and  severity  of  the  diseases  treated 
therein.  The  arrangement  of  the  diet  tables  is  based  upon  our 
knowledge  of  the  relative  digestibility  of  the  different  sorts  of  food, 
and  the  part  which  the  different  portions  of  the  digestive  tract  take 
in  the  process  of  digestion. 

The  diets  usually  found  in  military  hospitals  are  full,  light,  liquid, 
and  special. 

Full  diet  includes  what  is  served  at  the  table  in  the  dining-room; 
the  other  diets  are  ordinarily  served  in  the  wards. 

Light  diet  includes  liquids  and  the  simpler  and  more  digestible 
articles  of  solid  or  semisolid  food.  Each  surgeon  usually  has  his 
own  diet  list ;  the  following  table,  which  has  been  used  at  the  U.  S. 
Army  General  Hospital,  Presidio  of  San  Francisco,  California,  may 
be  taken  as  an  illustration  of  full  and  light  diets. 

In  addition  to  the  regular  diet  tables  a  special  diet  list  is  provided 
for  the  use  of  ward  surgeons  for  cases  requiring  this  kind  of  diet. 

Liquid  diet:  This  includes  liquids  only,  such  as  milk,  strained 
soups,  gruels,  broths,  albumen  water,  etc.  The  amount  of  each  of 
these  articles  to  be  taken  by  a  patient  in  twenty-four  hours  should 
always  be  stated. 

Special  diet:  This  is  usually  a  list  from  which  special  articles  of 
food  are  prescribed  for  particular  cases. 

As  to  which  diet  shall  be  given  to  a  particular  patient  depends 
upon  the  nature  of  the  case.  In  all  fevers  and  grave  disorders, 
while  there  is  increased  necessity  for  food  to  repair  the  unusual 
waste,  there  is  unfortunately  also  diminished  power  of  digestion  and 
assimilation. 

Therefore  we  begin  with  liquid  foods  to  save  the  digestive  appa- 
ratus the  labor  of  liquefying  them,  and  we  give  them  in  small  quan- 
tities and  frequently. 

If  there  is  irritation  of  the  stomach  and  bowels  we  give  those  foods 
which  have  the  least  indigestible  residue  to  irritate  the  bowels.  From 
liquids  we  go  on  to  jellies,  custards,  ice  cream,  light  puddings,  milk 
toast,  lightly  boiled  eggs,  chicken,  rare  steak,  etc. 


264 


MESS  MANAGEMENT  AND  COOKING 


FULL   DIET 


Breakfast 


Dinner 


Supper 


Sunday. 
Cereal  and  milk. 
Ham  and  eggs. 
Bread  and  butter. 
Fruit. 
Coffee. 


Monday. 
Cereal  and  milk. 
Beefsteak. 
Fried  potatoes. 
Bread  and  butter. 
Fruit.     Coffee. 

Tuesday. 
Cereal  and  milk. 
Sausage. 
Fried  potatoes. 
Bread  and  butter. 
Coffee.    Fruit. 

Wednesday. 
Milk  toast. 
Beefsteak. 
Bread  and  butter. 
Coffee.     Fruit. 


Thursday. 
Cereal  and  milk. 
Hash. 

Bread  and  butter. 
Coffee.    Fruit. 


Friday. 
Cereal  and  milk. 
Bacon  and  eggs. 
Bread  and  butter. 
Coffee.     Fruit. 


Saturday. 
Cereal  and  milk. 
Beefsteak. 
Fried  potatoes. 
Bread  and  butter. 
Coffee.    Fruit. 


Vermicelli  soup. 

Roast  veal,  sage-dressing,  or 
turkey,  or  chicken  and  dress- 
ing. 

Stewed  peas.     Mashed  potatoes. 

Farina  pudding.     Fruit. 

Bread  and  butter,  coffee. 


Roast  beef. 

Mashed  potatoes.    String  beans. 

Tapioca  pudding. 

Bread  and  butter.    Fruit. 

Coffee. 


Vegetable  soup. 

Baked  pork  and  beans. 

Baked  tomatoes. 

Bread  pudding. 

Bread,  butter,  cocoa,  fruit. 


Roast  mutton  with  dressing. 
Mashed  potatoes. 
Corn  or  fresh  vegetables. 
Chocolate  pudding,  fruit. 
Bread,  butter,  coffee. 


Oyster  soup. 

Corned  beef  and  cabbage. 
Boiled  potatoes.     Radishes. 
Rice  pudding.     Fruit. 
Bread,  butter,  coffee. 


Baked  fish  with  sauce. 
Plain  boiled  potatoes. 
Fresh  salad. 

Farina  pudding.    Fruit. 
Bread,  butter,  cocoa. 


Roast  beef,  veal,  or  pork. 

Mashed  potatoes. 

Hot  slaw.     Cauliflower. 

Bread  pudding. 

Bread,  butter,  coffee. 


Veal  stew  or  boiled  ham. 

Apple  sauce. 

Cake. 

Bread  and  butter. 

Tea. 


Codfish  balls  or  hash. 

Bread  and  butter. 

Pickles. 

Jam.     Sweet  crackers. 

Prunes.    Tea. 


Fried  liver  and  bacon. 
i  Corn  bread  and  syrup,  or 
i  Biscuits. 

Bread,  butter,  tea. 

Fruit. 


Mutton  stew. 
Pickles.     Sweet  crackers. 
Bread,  butter,  tea. 
Peach  cobbler. 


Sliced  roast  beef. 
Macaroni  and  cheese. 
Preserves. 
Bread  and  butter. 
Tea. 


Salmon  salad.     Potato 

salad. 
Apple  sauce. 
Ginger  crackers. 
Bread  and  butter.    Te: 


Baked  hash  or  stew. 
Stewed  prunes. 
Assorted  cakes. 
Bread  and  butter. 
Tea. 


MESS  MANAGEMENT 


265 


LIGHT  DIET 


Breakfast 


Dinner 


Supper 


Sunday. 
Cereal  and  milk. 
Soft-boiled  eggs. 
Milk  toast.    Coflfee. 

Monday. 
Cereal  and  milk. 
Milk  toast. 
Boiled  eggs. 
Coffee. 

Ttiesday. 
Cereal  and  milk. 
Boiled  eggs. 
Coffee. 

Wednesday. 
Cereal  and  milk. 
Soft-boiled  eggs. 
Coffee. 

Thursday. 
Cereal  and  milk.. 
Boiled  eggs. 
Coffee. 

Friday. 
Cereal  and  milk. 
Boiled  eggs. 
Milk  toast. 
Coffee. 

Saturday 
Cereal  and  milk. 
Boiled  eggs. 
Coffee. 


Rice  soup. 
Farina  pudding. 
Coffee. 


Plain  tomato  soup. 

Bread  pudding  with  lemon 

sauce. 
Coffee. 


Barley  soup. 
Tapioca  pudding. 
Cocoa. 


Consomme   vermicelli. 
Cornstarch  pudding. 
Vanilla  sauce.     Coffee. 


Oyster  soup. 
Rice  pudding. 
Coffee. 


Fish  chowder. 
Farina  pudding. 
Cocoa, 


Vermicelli  soup. 
Sago  pudding. 
Coffee. 


Milk  toast. 
Cup  custard. 
Tea. 


Farina  mush  and  milk. 
Sweet  crackers.      Jelly. 
Toast. 
Tea. 


Biscuits  or  corn  bread. 
Maple  syrup.    Boiled  rice. 
Milk  toast  and  tea. 


Sweet  crackers. 
Milk  toast. 
Tea. 


Jam. 


Macaroni  and  cheese. 
Milk  toast.     Maple  syrup. 
Tea. 


Tapioca  pudding. 

Milk        toast.         Ginger 

crackers. 
Boiled  eggs.     Tea. 


Cereal  mush. 
Assorted  Cakes.     Jelly. 
Milk  toast.     Tea. 


CHAPTER   II 

COOKING 

Practical  cooking  can  only  be  learned  in  the  kitchen  where  each 
hospital-corps  man  must  serve  an  apprenticeship,  those  who  show 
aptitude  being  given  an  opportunity  to  develop  into  cooks.  But  the 
principles  of  cooking  and  diet  cooking  must  be  learned  by  all. 

Nearly  all  food  is  capable  of  prompt  putrefaction ;  putrefaction  is 
due  to  the  growth  of  germs,  and  requires  the  presence  of  heat,  mois- 
ture, and  organic  matter;  if  any  one  of  these  conditions  is  absent 
putrefaction  will  not  take  place.  Hence  meats  will  keep  indefinitely 
when  frozen  (absence  of  a  suitable  temperature);  when  dried 
(absence  of  moisture)  ;  canned  (absence  of  germs  which  have  been 
destroyed  by  heat)  ;  or  when  pickled  (absence  of  germs  which  have 
been  killed  by  antiseptics,  such  as  salt,  vinegar,  and  sugar). 

A  clean  kitchen  means  the  practical  absence  of  germs;  in  such  a 
kitchen  foods  do  not  spoil  or  putrefy. 

The  following  extracts  from  an  old  work  on  "'  Camp  Fires  and 
Camp  Cooking  "  are  worth  repeating  here : 

"  Cleanliness  is  next  to  godliness,  both  in  person  and  kettles :  Be 
ever  industrious,  then,  in  scouring  your  pots.  Much  elbow  grease,  a 
few  ashes,  and  a  little  water  are  capital  aids  to  the  careful  cook. 
Dirt  and  grease  betray  the  poor  cook  and  destroy  the  poor  soldier, 
whilst  health,  content,  and  good  cheer  should  ever  reward  him  who 
does  his  duty  and  keeps  his  kettles  clean.  In  military  life,  punctu- 
ality is  not  only  a  duty,  but  a  necessity,  and  the  cook  should  always 
endeavor  to  be  exact  in  time.  Be  sparing  with  sugar  and  salt,  as  a 
deficiency  can  be  better  remedied  than  an  overplus. 

"  Remember  that  beans,  badly  boiled,  kill  more  than  bullets ;  fat  is 
more  fatal  than  powder.  In  cooking,  more  than  anything  else  in  the 
world,  always  make  haste  slowly.  One  hour  too  much  is  vastly 
better  than  five  minutes  too  little,  with  rare  exceptions.  A  big  fire 
scorches  your  soup,  burns  your  face,  and  crisps  your  temper.  Skim, 
simmer,  and  scour  are  the  true  secrets  of  good  cooking." 

(266) 


COOKING  267 

Cooking  improves  the  flavor  of  food  and  thereby  increases  the 
appetite ;  it  destroys  all  parasites  and  disease  germs ;  and  it  enables 
the  food  to  be  more  thoroughly  masticated  and  digested. 

It  lessens  the  toughness  of  muscular  fibres,  gelatinizes  the  connec- 
tive tissue,  coagulates  albumin,  breaks  up  the  starch  granules  and 
practically  converts  them  into  glucose  and  dextrin,  all  of  which  per- 
mits of  more  thorough  penetration  of  the  digestive  fluids  and  more 
rapid  digestion. 

The  ordinary  processes  of  cooking  are  boiling,  stewing,  roasting, 
baking,  frying,  and  broiling  or  grilling. 

In  boiling,  the  object  is  to  cook  the  food  and  at  the  same  time 
retain  in  it  all  its  natural  juices.  To  do  this  with  fresh  meat  and 
vegetables  the  water  should  be  salted,  and  the  food  in  large  masses 
dropped  at  once  in  boiling  water ;  this  by  coagulating  the  albumin  in 
■the  outer  layers  forms  a  protecting  coating  which  prevents  the  juices 
from  escaping. 

Active  boiling  is  continued  for  five  minutes,  after  which  the  process 
should  be  one  of  simmering  or  very  slowly  boiling. 

Salt  meats,  beans,  and  pease  should  be  put  on  in  cold  water  and 
the  temperature  slowly  raised. 

Potatoes  should  be  boiled  in  their  jackets,  but  if  peeled  the  water 
should  be  salted  to  prevent  the  escape  of  the  vegetable  salts. 

Fish  and  potatoes  should  be  thoroughly  drained  after  boiling. 
Beans,  pease,  rice,  and  other  hard  grains  require  a  preliminary  soak- 
ing ;  the  two  former  can  not  be  cooked  in  hard  water.  Fresh  meats 
require  about  fifteen  minutes  to  the  pound. 

In  stewing  meats  we  do  not  mind  the  escape  of  the  juices  because 
the  broth,  as  the  water  in  which  meat  is  boiled  is  called,  forms  a  part 
of  the  food,  all  of  which  is  to  be  eaten.  Therefore  the  meat  is  cut  in 
small  pieces,  placed  in  cold  water,  and  the  boiling  done  very  slowly ; 
vegetables  are  usually  added.  If  the  stew  is  made  with  meat  which 
has  already  been  cooked  it  is  known  as  a  hash. 

In  soup  making  the  broth  is  the  part  used,  hence  we  desire  to  get 
out  of  the  meat  and  bones  and  into  the  water  all  that  can  be  extracted 
of  their  nutritive  ingredients,  and  especially  the  gelatin  which  is  a 
result  of  a  prolonged  boiling  of  the  bone  and  connective  tissues.  The 
meat  is  cut  in  small  pieces  and  the  bones  thoroughly  cracked,  and  all 
placed  in  cold  water  in  a  covered  pot  which  should  simmer  slowly 
and  be  frequently  skimmed.    The  product  when  finished  constitutes 


268  MESS  MANAGEMENT  AND  COOKING 

stock,  and  the  various  soups  are  prepared  by  adding  vegetables  cut 
into  small  pieces,  and  cooking  for  an  hour  or  so  more  or  until  the 
vegetables  are  done.  Soup  stock  should  not  be  kept  in  an  iron  pot 
because  the  iron  gives  it  an  unpleasant  flavor. 

In  making  meat  teas  or  extracts  by  heat,  the  process  is  a  little 
different  from  soup  making;  we  do  not  wish  any  fat,  hence  lean  meat 
is  selected  without  bone,  and  all  fat  is  removed  after  the  broth  is 
cold ;  the  water  should  never  come  to  a  boil  so  as  not  to  coagulate  the 
albumin  which  we  wish  to  retain. 

Roasting  is  properly  done  in  front  of  a  clear  fire  with  special 
arrangements  for  concentrating  the  heat  and  turning  the  joint.  In 
this  country  the  term  roast  is  ordinarily  applied  to  baked  meats. 

Baking  is  done  in  an  oven,  and  as  the  fat  acids  developed  by  high 
temperature  can  not  escape,  the  flavor  and  digestibility  are  not  so 
good  as  in  roasting.  As  in  boiling,  our  object  is  to  expose  the  roast 
to  a  high  temperature  in  order  to  coagulate  the  surface  layer  so  that 
it  may  retain  the  juices;  when  that  is  accomplished  the  balance  of 
the  cooking  is  done  more  slowly  at  a  lower  temperature.  Frequent 
basting  with  the  melted  fat  and  meat  juices  is  necessary  in  order  to 
prevent  the  surface  becoming  too  tough  and  hard,  and  to  secure 
better  penetration  of  the  heat  into  the  interior  of  the  joint.  The 
oven  must  not  be  too  hot;  if  the  hand  and  arm  can  be  held  in  the 
oven  for  fifteen  seconds  the  temperature  is  about  right.  Baking 
ordinarily  requires  about  fifteen  minutes  to  the  pound. 

Broiling  or  grilling  is  practically  the  same  as  roasting  only  the 
cooking  is  done  over  instead  of  in  front  of  the  fire,  and  a  larger 
extent  of  surface  is  exposed  to  the  heat. 

The  meat  is  placed  on  a  gridiron  or  broiler  over  a  clear  bright  fire 
free  from  smoke.  If  the  broiling  is  done  before  a  fire  instead  of 
over  it,  the  juices  can  be  caught  in  a  drip  pan  and  used. 

Frying  is  properly  done  by  dropping  the  meat  or  vegetables  in 
boiling  oil  or  fat  at  a  temperature  of  about  500°  F.  and  in  a  frying 
pan  deep  enough  to  immerse  the  article  to  be  cooked.  If  the  fat 
is  hot  enough  the  surface  layer  of  the  meat  is  at  once  coagulated  as 
in  boiling  and  roasting,  and  the  grease  does  not  penetrate. 

Frying  is  usually  improperly  done,  the  bottom  of  the  frying  pan 
being  only  greased  enough  to  prevent  the  meat  from  sticking  to  it ; 
articles  thus  friend  are  saturated  with  grease  and  indigestible. 

The  object  of  bread  making  is  to  convert  an  indigestible,  tasteless 


COOKING  269 

mass  of  flour  into  an  appetizing,  porous  food  capable  of  ready  pene- 
tration by  the  digestive  juices  and  known  as  bread. 

The  first  step  is  to  make  the  dough,  which  is  done  by  thoroughly 
mixing  or  kneading  the  flour  with  salt  and  water ;  the  next  step  is  to 
impart  the  necessary  porosity  by  the  introduction  of  carbonic-acid 
gas  into  the  mass ;  this  done  by  either  generating  it  within  the 
dough  or  forcing  it  in  from  without. 

The  first  of  the  methods  may  be  effected  either  by  fermentation 
of  yeast  or  by  baking  pawders;  the  second  constitutes  the  so-called 
aerated  bread,  a  process  little  used  in  this  country. 

The  carbonic-acid  gas  is  held  in  minute  bubbles  by  the  tenacity 
of  the  gluten,  the  nitrogenous  element  of  flour,  and  the  dough  rises, 
becoming  light  and  spongy.  It  is  then  kneaded  over  again,  divided 
into  loaves  of  suitable  size,  allowed  to  rise  for  about  one  hour  in  the 
forms,  and  then  baked,  by  which  the  gas  is  still  further  expanded,  the 
dough  made  lighter,  and  the  porosity  permanently  fixed  in  the  bread. 

By  leavened  bread  we  mean  that  which  has  been  made  by  fermen- 
tation ;  yeast  may  be  used  directly,  or  we  may  use  a  portion  of  old 
fermenting  dough  or  leaven;  the  former  is  preferable. 

In  the  growth  of  the  yeast  fungus  a  portion  of  the  sugar  of  the 
dough  is  converted  into  alcohol  and  carbonic  acid;  the  former  is 
driven  off  by  the  heat  in  baking,  and  the  latter  is  spread  through  the 
dough,  making  it  porous.  Usually  a  portion  of  the  flour  is  first  made 
into  dough  with  yeast,  salt,  and  water,  and  set  aside  in  a  warm  place 
for  a  couple  of  hours,  this  constituting  the  sponge  which  is  subse- 
quently thoroughly  kneaded  with  the  remainder  of  the  flour  and 
water,  and  the  fermentation  allowed  to  proceed  in  the  entire  mass. 

The  important  point  is  to  know  just  when  it  has  gone  far  enough ; 
if  it  goes  too  far  the  bread  becomes  sour;  if  not  far  enough  it  is 
heavy. 

The  necessary  carbonic  acid  may  also  be  generated  by  the  use  of 
baking  powders;  these  consist  generally  of  bicarbonate  of  soda  mixed 
with  cream  of  tartar,  acid  phosphate  of  lime,  or  alum ;  in  the  chemi- 
cal reaction  which  takes  place  in  the  dough  carbonic-acid  gas  is  set 
free  and  certain  more  or  less  harmless  salts  remain  in  the  bread. 
Alum  baking  powders  are  objectionable  because  the  remaining  salts 
are  believed  to  cause  indigestion. 


CHAPTER    III 

RECIPES 

The  following  recipes  are  taken  from  the  valuable  pamphlet  on 
"  Emergency  Diet  for  the  Sick  in  the  Military  Service,"  by  Captain 
Edward  L.  Munson,  assistant  surgeon,  U.  S.  Army,  and  published 
with  his  permission.  They  will  serve  an  excellent  purpose  in  prepar- 
ing foods  for  the  sick  and  also  in  the  instruction  of  the  hospital  corps 
in  cooking  and  diet  cooking: 


LIQUID   DIET 


Sterilized  Milk 
Pour  the  milk  Into  a  granite  saucepan  (or  a  double  boiler)   and  raise  the 
temperature  of  milk  to  about  190°  Fahrenheit.     Keep  it  at  this  point  for  one 
hour.    Do  not  boil  the  milk.     Any  utensil  used   for  this  purpose  must  be 
absolutely  clean. 

Milk  Punch 

Three-fourths  of  a  coffee  cup  of  milk  (six  ounces). 

Two  tablespoonfuls  of  brandy  or  whisky. 

One  teaspoonful  of  sugar. 

Grated  nutmeg  to  taste. 

Sweeten  the  milk  (preferably  sterilized)  with  the  sugar.  Stir  into  it  the 
brandy.  Shake  it  up  well  by  pouring  from  one  cup  into  another,  or  by  the 
use  of  a  milk-shaker,  until  a  froth  is  formed.  Grate  a  little  nutmeg  on  top 
and  serve. 

The  term  "  cup  "  in  this  recipe,  as  in  all  others,  means  the  ordinary  coffee 
cup,  holding  eight  ounces. 

Milk  with  Mineral  or  Aerated  Waters 

Mix  equal  quantities  of  sterilized  milk  with  seltzer,  soda  water,  or  lime 
water,  and  serve  immediately. 

Albuminized  Milk 
Beat  up  the  white  of  an  egg  till  light.     Add  a  good-size  pinch  of  salt,  and 
four  ounces  of  fresh,  cool  milk  which  has  been  sterilized.     A  little  sugar  may 
be  added  if  desired. 

(270) 


LIQUID  DIET  271 

Peptonized  Milk  (Cold  Process) 

Into  a  clean  quart  bottle  put  two  peptonizing  tablets  dissolved  in  four 
ounces  of  cold  water.  Add  one  pint  of  fresh  cold  milk,  shake  thoroughly, 
and  place  the  bottle  on  ice.    Use  clean  cotton  to  plug  the  bottle. 

In  place  of  the  peptonizing  tablets,  five  grains  of  pancreatine  and  fifteen 
grains  of  sodium  bicarbonate,  to  be  obtained  from  the  dispensary,  may  be 
employed. 

Peptonized  Milk    (Warm  Process) 

Into  a  clean  quart  jar  or  bottle  put  the  tablets  above  mentioned,  dissolved 
in  four  ounces  of  cold  water.  Add  one  pint  of  fresh  milk  and  shake  the 
whole  well.  Place  the  bottle  in  a  pan  or  kettle  of  hot  water  maintained  at 
such  a  temperature  that  the  hand  can  just  be  held  in  it  without  discomfort. 
Keep  the  bottle  iii  the  water  for  ten  minutes.  Put  on  the  ice  immediately 
after  removing  from  the  hot  bath,  to  check  further  digestion.  If  ice  is  not 
available  pour  the  milk  into  a  saucepan  and  heat  quickly  to  boiling. 

Whey- 
Warm  one  pint  of  milk  to  about  blood  heat,  or  about  ioo°  Fahrenheit. 
Dissolve  half  a  rennet  tablet  in  one  tablespoonful  of  cold  water.  Stir  it  into 
the  milk  and  let  it  stand  until  the  latter  is  curdled,  which  will  be  in  a  few 
minutes.  Break  up  the  curd  with  a  fork  and  strain  off  the  liquid  (whey). 
This  may  be  sweetened  with  sugar,  and  when  cooled  makes  a  refreshing 
drink  for  fever  patients. 

Junket 

Heat  one  pint  of  fresh  unboiled  milk  to  about  blood  heat,  or  about  lOo" 
Fahrenheit.  Dissolve  a  full  tablespoonful  of  sugar  in  it.  Add  half  a  rennet 
tablet  which  has  been  dissolved  in  one  tablespoonful  of  cold  water.  It  will 
set  the  milk  in  about  fifteen  minutes.  Put  in  a  cool  place  till  ready  to  be 
used.    It  can  be  served  plain,  or  with  cream,  sugar,  and  a  little  nutmeg. 

Farina  Gruel 

One  tablespoonful  of  farina. 

One  pint  of  water. 

One  teaspoonful  of  sugar. 

One-half  teaspoonful  of  salt. 

Into  one  pint  of  water,  raised  to  boiling,  put  a  half  teaspoonful  of  salt; 
then  add  the  farina  and  cook  for  twenty  minutes.  Flavor  with  sugar  and 
condensed  milk,  if  fresh  milk  is  not  available.     Strain  and  serve  hot. 

In  this  recipe,  as  in  others,  condensed  milk  is  used  in  a  strength  of  one 
teaspoonful  to  the  half  pint  of  gruel. 

Rice  Gruel 

Two  tablespoonfuls  of  rice. 
Or  one  tablespoonful  of  rice  flour. 
One  pint  of  boiling  water. 
One-half  teaspoonful  of  salt. 
One  teaspoonful  of  sugar. 


272  MESS  MANAGEMENT  AND  COOKING 

Wash  the  rice  thoroughly  in  two  waters,  after  removing  any  specks  that 
may  be  mixed  in  the  grain.  Have  the  cooking  water  boiling.  Add  the  salt 
and  then  the  rice.  Boil  for  two  hours,  when  the  rice  should  be  almost 
entirely  dissolved.  Strain.  Add  condensed  milk  and  sugar,  if  desired.  Some 
persons  prefer  the  use  of  salt  alone. 

If  ground  rice  or  rice  flour  is  used,  it  should  be  mixed  with  cold  water 
before  mixing  with  boiling  water,  and  requires  but  thirty  minutes'  boiling. 
Flavor  with  sugar  or  condensed  milk. 

Hard-Bread  Gruel 

Toast  hard  bread  thoroughly  and  grind  it  into  a  powder.  To  one  pint 
of  boiling  water,  to  which  one-half  teaspoonful  of  salt  has  been  added,  add 
two  tablespoonfuls  of  hard-bread  powder.  Boil  ten  minutes  and  then  strain. 
Flavor  with  one  teaspoonful  of  sugar  and  one  teaspoonful  of  condensed 
milk  to  each  cupful  of  the  gruel. 

Koumyss 

Dissolve  one-fourth  cake  of  compressed  yeast  (Fleischmann's)  in  a  little 
warm  water.  If  Fleischmann's  yeast  is  not  obtainable,  use  one-fourth  cake 
of  ordinary  compressed  yeast  or  half  a  fluid  ounce  of  bakers'  yeast.  Warm 
one  quart  of  fresh  milk  to  about  90°  Fahrenheit,  add  one  tablespoonful  of 
sugar  and  the  dissolved  yeast;  thoroughly  mix  and  put  into  a  stout  bottle, 
tying  a  small  piece  of  cloth  firmly  over  the  cork  to  hold  it  in  place.  Shake 
well,  and  allow  to  stand  for  six  hours  at  a  temperature  of  about  70°  Fahren- 
heit. Then  put  the  bottle  on  ice  upside  down,  and  ailow  to  stand  for  three 
days  before  using.  Condensed  milk  may  be  used  with  as  good  a  result  as 
fresh  milk.  Use  five  parts  of  water  to  one  part  of  condensed  milk,  and 
omit  the  sugar.  ' 

Lemonade 

One  small  lemon  or  lime. 

One  tablespoonful  of  sugar. 

Three-fourths  of  a  coffee  cup  of  water  (six  ounces). 

Wash  and  wipe  the  lemon  or  lime.  Squeeze  the  juice  into  a  glass  or  bowl. 
Then  add  the  sugar,  pour  on  the  water,  and  strain.  Serve  at  once.  Boiled 
or  sterilized  water  should  be  used.  »■. 

Orangeade 

One  orange. 

One  teaspoonful  of  sugar. 

Three-fourths  of  a  coffee  cup  of  water  (six  ounces). 

Wash  and  wipe  the  orange.  Squeeze  the  juice  into  the  sugar.  Add  the 
cold  water,  previously  boiled.     Strain  and  serve. 

Eggnog. 

One  egg. 

Two  teaspoonfuls  of  sugar. 

Three-fourths  of  a  coffee  cup  of  milk  (six  ounces). 

Salt  to  taste. 


LIQUID  DIET  273 

Beat  the  egg  up  till  light.  Add  sugar  and  salt  and  then  the  milk,  which 
is  better  when  not  too  cold.  With  the  addition  of  one  or  two  tablespoonfuls 
of  brandy  this  makes  a  very  strengthening  drink  for  convalescents. 

Egg  Lemonade 

One  egg. 

One  small  lemon. 

Two  teaspoonfuls  of  sugar. 

Beat  up  the  white  and  yolk  of  the  egg  separately ;  add  sugar  to  yolk.  When 
both  are  light,  mix  them  together  and  add  the  strained  juice  of  the  lemon. 
Pour  into  a  glass  and  serve  with  a  spoon. 

A  little  cold  water  may  be  added  if  the  beaten  egg  is  too  foamy. 

Sherry  and  Egg 

One  egg. 

One  teaspoonful  of  sugar. 

Two  tablespoonfuls  of  sherry  wine. 

Break  the  egg  into  a  bowl  and  add  the  sugar.  Beat  the  two  together  until 
they  are  thoroughly  mixed.  Add  two  tablespoonfuls  of  sherry  wine  and  an 
equal  quantity  of  cold  water.    Mix  thoroughly,  strain,  and  serve  immediately. 

Toast  Water 

Toast  three  slices  of  soft  bread  till  very  brown,  and  dry  throughout. 
Break  up  fine,  add  one  pint  of  boiling  water,  and  set  aside  for  fifteen 
minutes.  Turn  into  a  strainer  or  piece  of  gauze  and  strain.  The  water  thus 
obtained  may  be  used  plain,  or  a  little  sugar  or  condensed  milk  may  be 
added.     It  may  be  served  either  hot  or  cold. 

Cofieee 

To  each  cup  of  water  allow  one  tablespoonful  of  coffee,  freshly  roasted 
and  ground.  Have  the  water  boiling.  Mix  the  coffee  with  a  little  cold 
water  and  pour  it  into  the  boiling  water.  Let  the  whole  come  to  a  boil,  and 
then  set  aside  for  five  or  ten  minutes  to  steep  and  settle  before  using.  If 
muddy  it  may  be  cleared  by  boiling  with  egg  shells,  or,  in  their  absence,  by 
a  dash  of  cold  water.  Add  sugar  and  fresh  or  condensed  milk  to  flavor  as 
desired. 

Tea 

To  each  half-pint  of  boiling  water  add  one  teaspoonful  of  tea.  Let  it 
steep  or  infuse  for  five  minutes.  Never  let  tea  boil.  Add  sugar  and  fresh 
or  condensed  milk  to  flavor  as  desired. 

Beef  Juice 

Cut  a  lean  piece  of  steak,  from  the  round  or  other  good  portion,  about 
one-half  pound  in  weight.  Remove  all  fat  and  fibrous  tissue.  Broil  over  a 
clear,  hot  fire  so  that  the  meat  becomes  pink  and  full  of  juice.    It  should 

18 


274  MESS  MANAGEMENT  AND  COOKING 

not  be  merely  done  on  the  outside  and  raw  inside.    Cut  into  small  pieces 
and  squeeze  out  the  juice.    Add  a  little  salt  and  it  is  ready  to  serve. 

If  it  is  needed  warm,  place  the  cup  holding  the  juice  in  a  bowl  of  warm 
water.    Do  not  let  the  temperature  of  this  water  exceed  i6o°  Fahrenheit. 

Beef  Juice  (Bottled) 

Choose  a  good,  well-flavored  piece  of  beef,  half  a  pound  in  weight.  Cut 
away  the  fat,  leaving  only  the  lean.  Cut  this  up  into  small  pieces.  Put 
these  into  a  clean  glass  jar  and  cover  the  latter.  Set  the  jar  in  a  deep  sauce- 
pan of  cold  water  and  heat  gradually  for  one  hour.  Then  strain  out  the 
juice  and  press  the  meat.    Add  a  little  salt  and  serve. 

If  the  temperature  of  the  water  exceeds  i6o°  Fahrenheit  the  beef  juice 
becomes  brown  and  flaky.  A  half-pound  of  beef  should  give  from  three  to 
four  tablespoorifuls  of  juice. 

Beef  Tea  (Bottled) 
Select  and  prepare  the  beef  as  for  bottled  beef  juice,  except  that  to  each 
half-pound  of  meat  a  cup  of  cold  water  should  be  added,  pouring  the  water 
over  the  beef  after  it  has  been  put  in  the  jar.  The  liquid  thus  obtained  will 
resemble  the  beef  juice  in  every  respect  except  strength.  Add  a  little  salt 
and  serve. 

Beef  Tea  with  Hydrochloric  Acid. 

Select  and  prepare  the  beef  as  above.  Put  into  a  bowl  and  pour  over  it 
one  cupful  of  cold  water,  to  which  five  drops  of  dilute  hydrochloric  acid  have 
been  added.  Let  the  whole  stand  for  two  hours  in  a  cool  place.  Strain, 
add  salt  to  flavor,  and  serve  cold.  This  tea  may  be  heated;  but  the  albumin 
which  coagulates  and  appears  as  brown  flakes  should  not  be  strained  out, 
for  it  is  the  nutritious  portion  of  the  tea. 

Beef  (or  Mutton)  Broth 

One  pound  of  lean  beef  (or  mutton). 

One  quart  of  water. 

One  teaspoonful  of  salt. 

Soak  the  meat,  previously  chopped  fine,  in  the  cold  salted  water  for  at 
least  two  hours,  in  the  vessel  in  which  it  is  to  be  cooked,  keeping  it  on  ice 
or  in  a  cool  place  during  this  time.  Then  expose  to  moderate  heat.  Keep 
the  vessel  covered  and  allow  the  broth  to  simmer,  keeping  up  the  original 
quantity  of  water,  for  three  hours  at  least.  Let  it  cool  overnight,  skim  oflf 
the  fat  in  the  morning,  and  keep  covered  in  a  cool  place  until  needed.  Heat 
and  serve  as  required. 

Chicken  Broth 
Fowls  are  better  to  use  for  broth  than  young  chickens.  Pluck  and  pre- 
pare by  singeing  with  a  blazing  newspaper,  straw,  or  dry  grass.  Remove 
all  refuse  —  entrails,  oil  bag,  crop,  lungs,  etc.  Wash  well  in  cold  water,  then 
cut  up  and  disjoint.  To  each  pound  of  chicken  add  a  quart  of  cold  salted 
water  and  simmer  for  two  hours;  then  boil  for  two  hours.  Add  rice  or 
powdered  hard  bread  or  soft  bread  crumbs  in  the  proportion  of  one  table- 


SEMISOLID  OR  LIGHT  DIET  275 

spoonful  to  each  quart  of  water.  Vegetables,  such  as  onions,  garlic,  carrots, 
celery,  and  parsley,  may  be  also 'used,  a  tablespoonful  to  the  quart,  and 
should  be  put  in  when  the  broth  is  first  put  on  to  cook.  Strain,  remove  the 
fat,  and  serve  hot. 

Canned  Soups 

To  render  canned  soups  ready  for  eating,  simply  raise  them  to  the  boiling 
point  by  immersing  the  cans  in  boiling  water  for  half  an  hour  to  thoroughly 
heat  the  contents;  or  empty  and  heat  the  contents  in  a  granite  saucepan. 
After  diluting  with  the  proper  amount  of  water,  following  directions  on  the 
cans,  they  are  ready  to  serve.  Before  heating  any  canned  article  a  hole 
should  be  punctured  in  the  upper  end  of  the  can. 

Clam  Broth.  (Canned) 

This  may  be  served  hot  or  cold.  If  the  broth  is  desired  plain,  add  an 
equal  quantity  of  water  to  the  clam  juice  and  heat  to  the  temperature  required. 
Do  not  boil.  Clam  broth  can  also  be  given  iced.  If  fresh  milk  is  available, 
equal  parts  of  milk  and  clam  juice  may  be  heated  up  together. 


SEMISOLID  OR  LIGHT  DIET 


Poached  Eggs 

Pour  sufficient  boiling  water  into  a  clean  cooking  utensil  and  add  salt 
in  the  proportion  of  one  teaspoonful  to  the  quart  of  water.  Place  it  on  the 
stove  to  boil.  Break  a  fresh  egg  into  a  small  dish,  and  when  the  water  boils 
slide  the  egg  gently  into  it.  When  the  albumen  or  white  is  firm,  or  at  the  end 
of  two  minutes,  lift  the  egg  out  of  the  water  with  a  skimmer  and  place  it  on 
a  piece  of  hot,  nicely-browned  toast  or  hard-tack.  Sprinkle  with  a  little  salt 
and  pepper  and  serve  hot. 

Soft  Cooked  Eggs 
Put  into  a  saucepan  as  many  eggs  as  are  to  be  cooked.  Pour  over  them 
water  enough  to  cover.  The  water  should  have  been  brought  up  not  quite 
to  the  boiling  point.  Let  the  eggs  stay  in  the  water  from  seven  to  ten  minutes, 
and  the  result  is  an  evenly  cooked  egg  throughout.  When  the  water  is 
poured  on  the  eggs  do  not  set  the  pan  on  the  fire.  No  further  heating  is 
required,  but  the  water  should  not  be  allowed  to  cool  down  too  rapidly. 

Omelet 
Two  eggs. 

Two  tablespoonfuls  of  milk,  cream,  or  water. 
One-fourth  teaspoonful  of  salt. 
Pepper  to  taste. 

Beat  up  the  yolks  and  whites  of  the  eggs  separately.  Add  the  salt  to 
the  yolks.     Mix   the   whites   and  yolks   together   with   the  milk,   cream,   or 


276  MESS  MANAGEMENT  AND  COOKING 

water.  Place  a  small  piece  of  butter  or  bacon  fat  in.  a  pan  or  plate  hot 
enough  to  melt  it.  Pour  in  the  omelet,  and  with  a  sharp  knife  loosen  the 
edges  as  they  solidify  and  fold  over  the  omelet  into  a  half-circle.  When 
done,  turn  but  on  a  plate  and  serve  hot.  When  milk  can  not  be  had,  water 
may  be  used. 

Spanish  omelet  has  minced  onion  added  to  the  above.  An  excellent  addi- 
tion to  the  plain  omelet  is  a  dressing  made  of  canned  tomatoes  and  boiled 
crumbled  hard  bread,  strained,  seasoned,  and  heated  together.  Never  use 
flour  in  an  omelet,  as  it  can  not  be  cooked  sufficiently  in  the  short  time  that 
should  be  given  to  eggs. 

Baked  Custard 

One  pint  of  fresh  milk. 

Two  eggs. 

One-third  teaspoonful  of  salt. 

Two  tablespoonfuls  of  sugar. 

Small  piece  of  cinnamon. 

Put  the  cinnamon  in  the  milk  and  pour  into  a  saucepan  to  heat.  Break 
the  eggs  into  a  bowl  with  the  sugar  and  salt,  and  beat  until  well  mixed  but 
not  light.  When  the  milk  comes  to  a  boil  pour  it  over  the  eggs.  Stir  slowly 
to  dissolve  the  sugar.  Strain  the  mixture  into  cups,  set  them  in  a  deep  pan 
of  boiling  water,  and  bake  for  twenty  minutes  in  a  moderately  hot  oven. 

Dry  Toast 

Cut  the  bread  in  slices  one-third  of  an  inch  in  thickness.  Toast  may  be 
made  either  by  drying  bread  in  an  oven  and  then  placing  on  a  toaster  over 
the  fire,  or  the  bread  may  be  allowed  to  dry  and  brown  in  the  oven.  Toast 
that  is  moist  and  soft  in  the  middle  should- never  be  given  to  an  invalid. 
Have  it  dry,  crisp  throughout,  and  of  a  golden-brown  color.  Serve  hot, 
either  dry  or  buttered. 

Milk  Toast 
Put  a  cup  of  milk  into  a  saucepan  and  let  it  heat  to  the  boiling  point. 
Have  ready  three  slices  of  nicely  browned  bread.     Put  a  little  salt  in  the  milk 
and  pour  it  over  the  toast.    A  little  butter  may  be  spread  on  the  latter,  but 
it  is  a  more  delicate  dish  without  it.     Serve  hot. 

Oatmeal  Porridge  • 

Three  tablespoonfuls  of  oatmeal  or  rolled  oats. 

One  pint  of  boiling  water. 

One-fourth  teaspoonful  of  salt. 

Dissolve  the  salt  in  the  water,  then  add  the  oatmeal.  Cook  for  two  hours 
in  a  double  boiler.  Rolled  oats  require  cooking  only  half  an  hour.  Oat- 
meal is  very  appetizing  when  served  cold  in  mold  shapes,  and  it  will  frequently 
be  eaten  in  this  way  when  it  would  be  refused  if  served  in  any  other  form. 
Variations  may  be  made   by  using   farina,   browned   rice    (browned   in   the 


SEMISOLID  OR  LIGHT  DIET  277 

oven,  before  steaming  and  molding),  arrowroot,  etc.,  giving  further  change 
by  serving  occasionally  with  sweetened  fruit  juices,  fresh,  dried,  or  canned, 
instead  of  cream  or  milk. 

Farina  Mush,  or  Porridge 

Three  tablespoonfuls  of  farina. 

One  pint  of  boiling  water. 

One-half  teaspoonful  of  salt. 

The  water  must  be  boiling  before  putting  in  the  farina.  Boil  for  half  an 
hour.  It  may  be  served  with  fresh  milk,  or  condensed  milk  diluted  one  to 
four  parts  of  boiling  water,  or  with  stewed  dried  fruit,  such  as  prunes, 
peaches,  or  apples.  Cold  farina  mush  may  be  sliced  and  fried  for  the  use  of 
convalescents. 

Plain  Boiled  Rice 

One-half  cup  of  rice. 

Two  cups  of  boiling  water. 

One-half  teaspoonful  of  salt. 

Pick  the  rice  clean.  Wash  thoroughly  In  two  waters,  pouring  off  the 
last  when  ready  to  put  the  rice  into  the  boiling  water.  Add  the  salt  to  the 
water.  Pour  in  the  rice  and  boil  steadily  for  half  an  hour.  In  order  to  see 
if  the  rice  is  done,  take  out  some  of  the  grains  and  crush  between  the  fingers. 
If  done,  they  will  mash  easily  and  feel  perfectly  soft.  Do  not  stir  the  rice, 
as  this  will  cause  it  to  fall  to  the  bottom  and  burn.  Serve  with  sugar  and 
fresh  or  condensed  milk  or  with  stewed  fruits. 

Steamed  Rice 

Wash  the  rice  thoroughly  in  two  waters.  Use  in  same  proportions  as 
are  given  for  boiled  rice.  Use  a  double  boiler.  Have  the  water  boiling  in 
lower  boiler.  Place  the  above  mixture  of  rice,  boiling  water,  and  salt  in  the 
upper  chamber,  and  let  cook  for  one  hour.  Do  not  stir.  Keep  the  rice 
covered  while  steaming,  and  keep  the  lower  boiler  well  supplied  with  boiling 
water.     Serve  as  with  boiled  rice. 

Milk  Porridge 

The  flour  for  milk  porridge  should  be  prepared  in  the  following  manner: 
Tie  up  in  a  muslin  bag  or  towel  as  much  flour  as  desired  and  boil  for  four 
or  five  hours,  then  bake  in  an  oven  until  dry.  To  make  the  porridge,  grate 
two  tablespoonfuls  of  the  dried  flour,  mix  it  with  cold  water  into  a  paste, 
and  add  to  it  one  pint  of  boiling  milk  or  boiling  water.  Boil  for  ten  minutes. 
If  water  alone  is  used  to  make  the  porridge,  condensed  or  fresh  milk  may  be 
used  in  addition,  in  equal  parts  or  diluted  one-half  with  water. 

Condensed  milk  used  in  this  recipe  is  made  in  the  strength  of  one  part 
of  condensed  milk  to  four  of  water.  Salt  is  added  in  proportion  of  one  tea- 
spoonful to  the  quart  of  boiling  milk  or  water. 


278  MESS  MANAGEMENT  AND  COOKING 

Lemon  Jelly 

One-fourth  box  of  gelatin  (one-half  ounce). 

One-fourth  cup  of  cold  water. 

One-fourth  cup  of  fresh  lemon  juice  (about  the  amount  yielded  by  two 
lemons). 

Three  tablespoonfuls  of  sugar. 

One  and  one-fourth  cups  of  boiling  water. 

Put  the  gelatin  to  soak  in  the  cold  water,  about  twenty  minutes  being  re- 
quired for  this  process.  When  dissolved,  pour  on  the  boiling  water.  Add 
the  lemon  juice  and  sugar.  Stir  thoroughly  and  strain  through  a  fine-meshed 
cloth  into  a  china  or  granite-ware  mold,  cooling  in  a  refrigerator  or  by 
placing  in  a  pan  of  cold  water.     Never  use  tin  molds  for  lemon  jelly. 

CofEee  Jelly 

One-fourth  box  of  gelatin  (one-half  ounce). 

One-fourth  cup  of  cold  water. 

One  cup  of  boiling  water. 

One-half  cup  of  strong  coflfee. 

Two  tablespoonfuls  of  sugar. 

Soak  the  gelatin  in  the  cold  water  for  half  an  hour.  Pour  on  the  boiling 
water,  then  put  in  the  sugar  and  coffee.  Strain  it  through  a  cloth  into  a 
mold  or  dish  in  which  it  may  be  cooled,  either  in  a  pan  of  iced  water  or  in  a 
refrigerator.     Coflfee  jelly  may  be  served  with  cream  and  sugar. 

Have  the  coflfee  strong,  two  tablespoonfuls  of  coflfee  to  each  cup  of  water. 
Where  vanilla  extract  is  available,  one-half  teaspoonful  will  be  advanta- 
geously added  to  the  above  recipe. 

Wine  Jelly 

One-fourth  box  of  gelatin  (one-half  ounce). 

One-fourth  cup  of  cold  water. 

One-half  cup  of  sugar.  , 

One-half  cup  of  sherry  wine. 

One  and  one-fourth  cups  of  boiling  water. 

One  srnall  piece  of  cinnamon. 

Put  the  gelatin  and  cold  water  together  in  a  dish  large  enough  to  hold 
the  whole  mixture.  Let  it  soak  for  half  an  hour,  then  pour  the  boiling  water 
(in  which  the  piece  of  cinnamon  has  been  simmering)  over  the  softened  gel- 
atin. Add  the  sugar  and  wine,  strain  through  a  clean  cloth  into  a  china 
or  granite-ware  mold,  and  cool  in  a  refrigerator  or  a  pan  of  cold  water. 

Stewed  Dried  Apples,  Apricots,  or  Peaches 

Wash  the  fruit  thoroughly.  Soak  for  four  or  five  hours  in  the  cold  water 
it  is  to  be  cooked  in,  using  only  a  suflticient  quantity  of  water  to  cover.  Heat 
in  a  covered  granite-ware  saucepan,  simmering  slowly  for  two  hours.  Do 
not  boil.  If  the  fruit  is  allowed  to  simmer  it  will  not  burn  or  need  stirring, 
which  breaks  it  up  and  makes  it  look  unsightly.  Apricots  need  plenty  of 
sugar,  but  this  should  not  be  added  until  five  minutes  before  taking  ofT  the 


SEMISOLID  OR  LIGHT  DIET  279 

'fire.  Lemon  juice  or  lemon  peel  may  be  added  to  poorly  flavored  apples,  a 
tablespoonful  of  the  juice  or  the  peel  of  half  a  lemon  to  the  pound  of  fruit,  or 
spices  may  be  used  for  flavoring.  The  use  of  brown  sugar  in  stewing  dried 
fruit  is  to  be  preferred,  because  of  the  better  flavor  which  it  gives. 

Baked  Apples 
Select  fair,  sound,  and  preferably  tart  apples.  Wash  and  wipe  them  and 
cut  out  the  cores,  removing  all  the  seeds  and  husks.  Cut  off  any  dark  spots 
on  the  outside.  Put  the  prepared  apples  into  a  granite  or  earthenware  dish. 
Put  into  each  apple  from  one-half  to  one  teaspoonful  of  sugar,  according  to 
the  acidity  of  the  fruit,  and  a  bit  of  lemon  peel.  Pour  boiling  water  into  the 
dish  about  one-fourth  inch  deep,  and  bake  in  a  moderately  hot  oven.  When 
perfectly  soft  all  through,  the  fruit  is  done.  The  time  for  baking  varies, 
according  to  the  species  of  apple,  from  half  an  hour  to  two  hours. 

Canned  Fruit,  Serving  of 
Remove  from  cans  several  hours  before  using  and  put  in  porcelain  or 
granite-ware  dish  to  cool.  Canned  fruit  is  much  improved  by  cooling, 
being  more  palatable  and  refreshing  than  if  served  direct  from  the  can. 
Never  allow  fruit  to  remain  in  cans  when  once  opened.  This  applies  par- 
ticularly to  very  acid  fruit,  and  also  to  meats,  fish,  or  vegetables. 

Baked  Potatoes 

Have  the  potatoes  of  a  uniform  size,  so  that  all  may  be  done  at  the  same 
time.  Wash  them  thoroughly  and  bake  in  a  hot  oven  from  forty-five  to 
fifty  minutes.  They  are  recognized  as  being  done  by  the  soft,  yielding 
sensation  given  on  pinching. 

Roasted  Potatoes 
Bury  under  the  hot  ashes  of  an  open  fire  (camp)  for  half  an  hour  or  more. 
The  thoroughness  of  cooking  is  recognized  as  with  baked  potatoes.     Break 
open  by  squeezing.     Brush  the  ashes  off  first. 

Boiled  Potatoes 
Wash  the  potatoes  well.  Pare  carefully  so  as  not  to  waste.  Put  them 
on  to  cook  in  boiling  salted  water,  enough  to  cover,  and  let  boil  for  thirty 
minutes.  It  requires  more  time  for  large-size  potatoes.  When  easily 
pierced  with  a  fork  they  are  done.  Drain  off  the  water,  and  dry  them  on  top 
of  the  stove  by  moving  the  boiler  back  and  forth  for  a  minute  or  two.  Serve 
as  quickly  as  possible  after  they  are  cooked. 

IVCashed  Potatoes 
Prepare  as   for  boiled  potatoes.     When  cooked,  drain  off  the  water  and 
mash  in  the  dish  in  which  they  were  boiled.     Add  butter,  pepper,  and  salt 
to  taste,  and  lastly  put  in  a  lijttle  milk  or  cream.     Whip  up  lightly  and  serve 
immediately.     Keep  the  dish  covered  until  served. 


280  MESS  MANAGEMENT  AND  COOKING 

Scraped  Beef 
Cut  a  piece  of  steak  from  the  round,  about  half  a  pound  in  weight  and 
about  an  inch  thick.  Laj--  it  on  a  clean  meat-board  and  with  a  dull  knife 
scrape  out  the  pulp  until  there  is  nothing  left  but  stringy  fiber.  Season  the 
scraped  pulp  with  salt  and  make  it  into  small  cakes.  Broil  for  two  minutes 
either  by  direct  heat  over  a  clear  fire,  or  by  heating  a  clean  pan  or  plate  and, 
when  hot,  placing  the  meat  on  it.  Have  both  sides  cooked  sufficiently. 
This  is  a  safe  food  for  a  patient  beginning  to  take  solid  nourishment.  Scraped 
beef  may  be  prepared  very  easily  over  an  alcohol  lamp. 

Scraped  Beef  Sandwiches 

Place  a  piece  of  round  steak  on  a  meat-board  and  scrape  out  all  of  the 
pulp  with  a  dull  knife;  add  to  the  pulp  a  little  salt  and  pepper  and  enough 
raw  beef  juice  to  make  it  into  a  firm  jelly.  Have  stale  bread  cut  into  very 
thin  slices  and  spread  the  beef  pulp  on  them ;  cut  the  sandwiches  quite  small. 
Never  use  butter  in  making  beef  sandwiches. 

Broiled  Beefsteak 

Have  a  clear,  hot  fire,  either  coal  or  charcoal.  Put  the  steak  on  a  broiler, 
place  directly  over  the  fire  for  about  a  minute,  then  turn  and  do  the  same 
with  other  side.  By  applying  greater  heat  at  the  outset  the  juices  are  kept 
in  the  meat.  It  requires  from  five  to  seven  minutes  over  a  clear  fire  to  broil 
a  steak  an  inch  thick.  Season  both  sides  with  salt  and  a  little  pepper,  but 
no  butter.  Serve  hot.  A  baked  potato  is  a  good  vegetable  to  serve  with 
the  above,  as  is  also  boiled  rice. 

Another  good  way  to  broil  steak  is  to  heat  a  granite-ware  plate  on  a 
stove  till  it  is  quite  hot.  Place  the  steak  on  it  till  one  side  is  done,  then  turn 
it  and  do  the  same  with  other  side. 

Stewed  Chicken. 

Boil  a  chicken,  prepared  as  for  broth,  until  tender.  Set  it  away  till  it  is 
cool.  Skim  off  the  fat;  take  the  meat  and  cut  it  up  in  cubes  or  small  pieces, 
rejecting  all  skin,  gristle,  tendons,  and  bones.  To  one  cupful  of  the  meat 
add  one  pint  of  the  broth,  seasoning  with  salt  and  pepper.  Mix  one  tea- 
spoonful  of  flour  with  a  little  cold  water,  blend  it  thoroughly,  and  add  it  to 
the  chicken.  Let  the  whole  stew  for  ten  minutes,  and  serve  with  toast  or 
boiled  rice. 

Minced  Chicken  on  Toast 

Prepare  the  chicken  as  for  broth.  When  cool,  skim  off  the  fat  and  mince 
up  the  meat  fine,  rejecting  all  skin,  tendons,  gristle,  and  bone.  Season  with 
salt  and  a  little  pepper.  Add  enough  broth,  or  better  yet,  cream,  if  available, 
to  make  it  of  the  proper  consistency,  or  about  that  of  cream.  Have  ready 
some  nicely-browned  dry  toast,  pour  the  minced  chicken  over  it,  and  serve  hot. 


THE  RATIONS  281 

THE  HOSPITAL  STORES 


Beef  Extract  (Liquid) 

To  four  ounces  of  cold,  sterilized  water  add  half  a  teaspoonful  to  one 
teaspoonful  of  the  liquid  extract.  Mix  thoroughly;  season  with  salt  and 
pepper  to  taste,  and,  if  obtainable,  with  celery  salt. 

Where  a  hot  beef  tea  is  required  the  above  preparation  may  be  heated, 
care  being  taken  not  to  remove  the  nutritious  curdy  flakes  produced  by  boiling. 

Malted  Milk 

Mix  one  or  two  tablespoonfuls  of  malted  milk  with  a  like  quantity  of 
warm,  boiled  water.  Add  more  water  to  make  up  half  a  pint.  Season  with 
salt  to  taste. 

Boiling  water  can  not  be  used  to  advantage  in  making  up  this  preparation. 

Chocolate 
Grate  one  ounce  of  chocolate.  Have  ready  one  pint  of  boiling  milk.  Mix 
the  grated  chocolate  with  some  hot  milk  into  a  paste,  add  to  it  the  boiling 
milk  and  boil  five  or  six  minutes.  Flavor  with  sugar,  one  teaspoonful  to  the 
pint.  The  chocolate  issued  in  the  hospital  stores  is  partly  sweetened.  If 
unsweetened  chocolate  is  used,  a  tablespoonful  of  sugar  is  required.  If  fresh 
m'lk  is  not  available,  make  the  chocolate  with  boiling  water  and  add  one 
teaspoonful  of  condensed  milk  to  each  half  pint  of  chocolate. 

Arrowroot  Blanc-Mange 

Two  tablespoonfuls  of  arrowroot. 

Two-thirds  pint  of  hot  water. 

Two  tablespoonfuls  of  sherry  or  brandy. 

Two  teaspoonfuls  of  sugar. 

Mix  the  arrowroot  into  ^  smooth  paste  with  three  tablespoonfuls  of  cold 
water.  Add  this  to  the  hot  water.  Bring  to  a  boil,  stirring  constantly  till 
well  blended  and  free  from  lumps.  Let  boil  for  ten  minutes.  Add  the 
sugar  and  sherry  or  brandy.  Beat  up  quickly  and  pour  into  a  bowl  or  mold 
to  cool.  Arrowroot  blanc-mange  may  be  made  with  fresh  hot  milk  or  con- 
densed milk  diluted.  If  boiling  water  is  used  it  causes  the  starch  of  the 
arrowroot,  when  first  poured  in,  to  form  into  lumps.  Hence  it  is  best  to 
have  the  water  not  quite  at  boiling  point. 


THE  RATIONS 


Hard-Bread  Toast  Water 
Two  tablespoonfuls  of  powdered  hard  bread 
One  pint  of  boiling  water. 
One-half  teaspoonful  of  salt. 


282  MESS  MANAGEMENT  AND  COOKING 

Add  the  powdered  hard  bread,  after  toasting  or  parching  in  an  oven,  to 
the  salted  boiHng  water.  Boil  for  ten  minutes.  Strain  through  gauze  and 
serve  hot  or  cold.  The  toast  water  may  be  flavored  with  sugar,  condensed 
milk,  or  whisky. 

Hard-Bread  Mush  or  Porridge 

One  cup  of  powdered  hard  bread. 

Four  cups  of  boiling  water. 

One  teaspoonful  of  salt. 

Mix  and  boil  for  ten  minutes.  The  resulting  mush  may  be  eaten  with 
condensed  milk  or  stewed  dried  fruit. 

Care  should  be  taken  to  prevent  scorching  by  frequent  stirring,  and  the 
water  should  be  boiling  in  all  cases  before  adding  the  powdered  bread. 

Hard  Bread  as  Milk  Toast 
Toast  two  or  three  pieces  of  hard  bread  to  a  good  brown  color  by  placing 
in  an  oven  or  over  a  clear  fire  on  a  toaster.  When  done,  pour  enough  boil- 
ing water  over  them  to  soften  thoroughly.  Dilute  two  tablespoonfuls  of 
condensed  milk  in  four  times  as  much  boiling  water.  Drain  off  the  water 
from  the  toasted  bread  and  pour  on  the  milk.     Serve  hot. 

Hard  Bread  and  Dried  Apples  (Brown  Betty) 
Soak  the  dried  apples  for  at  least  four  hours.  Grease  a  baking  pan  or 
dish  and  place  in  it  first  a  layer  of  sliced  apples,  then  a  layer  of  hard-bread 
crumbs,  or  whole  hard  bread  softened  in  boiling  water  for  ten  minutes,  with 
small  quantities  of  butter  or  fat  pork  and  sugar,  and  a  little  ground  cinna- 
mon sprinkled  over  each  layer.  Continue  till  the  dish  is  full,  having  bread 
crumbs  for  the  top  layer.  Moisten  with  a  cup  of  water,  or  fresh  or  diluted 
condensed  milk,  and  bake  three-quarters  of  an  hour  in  a  moderately  heated 
oven.  When  a  fork  easily  pierces  the  apples  the  pudding  is  cooked.  It 
can  be  eaten  hot  or  cold  with  butter  and  sugar  worked  up  together  and 
flavored  with  cinnamon  or  nutmeg;  with  a  simple  sirup  of  sugar  and  water, 
or  with  the  following  sauce : 

Sauce  for  Hard-Bread  Pudding 

One  pint  of  boiling  water. 

One  tablespoonful  of  flour. 

One-half  cup  of  sugar. 

One  lemon. 

To  the  water  add  the  flour,  mixed  into  a  paste  with  three  tablespoonfuls 
of  cold  water.  Boil  for  ten  minutes.  Add  the  sugar  and  lemon  juice, 
strained ;   or  other  flavoring  to  taste. 

'ijacon,  Broiled 
Wash  in  cold  water.     Cut  into  thin  slices  and  broil  over  clear  coals,  either 
on  a  broiler  or  with  a  fork.     Serve  immediately. 


THE  RATIONS  283 

Bacon,  Fried 

Cut  into  thin  slices  after  washing,  roll  in  hard-bread  crumbs,  and  fry  in  a 
very  hot  pan  which  has  been  greased.  Season  with  pepper  and  serve  imme- 
diately.    The  bacon  may  be  fried  without  the  bread  crumbs  if  preferred. 

Bacon,  Boiled 

Wash  the  bacon  in  cold  water.  Scrape  and  trim  off  any  rusty  or  brownish 
spots,  and,  if  very  hard  or  dry,  soak  for  a  few  hours  in  cold  water.  Put 
it  on  to  cook  in  enough  cold  water  to  cover  it  well,  let  it  come  slowly  to  a 
boil,  and  then  boil  steadily  until  done.  As  the  water  evaporates  or  boils 
away,  replenish  it  with  more  boiling  water.  When  the  bacon  can  be  easily 
pierced  with  a  fork  in  the  thickest  part,  it  is  sufficiently  cooked.  Save  the 
fat,  it  will  be  useful  in  frying;  and  if  greens  are  to  be  cooked,  leave  enough 
in  the  water  to  season  them. 

Canned  Boast  Beef  Soup 

One  pound  (one-half  can)  of  roast  beef. 

One  pint  of  cold  water. 

Salt  and  pepper  to  taste. 

Cut  the  beef  into  small  pieces  and  add  it  to  the  cold  water.  Let  the 
whole  come  to  a  boil  and  then  simmer  gently  for  half  an  hour.  Skim  off 
the  fat  and  strain,  taking  care  to  express  all  the  meat  juice  and  gelatin  from 
the  meat.  Season  with  salt  and  pepper  to  taste.  A  little  beef  extract,  when 
added  to  the  above,  improves  the  value  and  palatability  of  this  soup.  A 
tablespoonful  of  hard  bread,  powdered,  may  be  added  if  rice  and  other  grains 
are  not  available. 

Canned  Roast  Beef  Stew 

Two  pounds  of  canned  roast  beef. 

Six  small  potatoes. 

One  onion. 

Salt  and  pepper  to  taste. 

Wash,  peel,  and  slice  the  vegetables.  Cover  them  with  sufficient  boiling 
salted  water.  Put  them  on  to  boil,  and  when  nearly  done  add  the  roast 
beef,  well  cut  up.  Season  to  taste  with  pepper  and  salt,  and  let  the  whole 
simmer  ten  or  fifteen  minutes  before  serving.  If  potatoes  are  not  to  be  had, 
hard  bread,  crumbled  and  softened  in  boiling  water,  may  be  used  with  the 
meat-  Canned  tomatoes,  in  varying  proportions,  make  a  good  addition  to 
the  stew,  as  already  described.  In  the  absence  of  any  other  vegetables,  they 
may  be  added  to  the  meat  in  the  proportion  of  pound  for  pound. 

Canned  Roast  Beef  Hash 

Two  pounds  of  canned  roast  beef. 

Six  boiled  potatoes,  small. 

One  onion. 

Pepper  and  salt  to  taste. 


284  MESS  MANAGEMENT  AND  COOKING 

Chop  up  the  meat  and  vegetables  thoroughly.  Mix  well.  Season  with 
pepper  and  salt  and  brown  in  a  hot  dish  or  frying  pan,  previously  greased 
with  pork  or  bacon,  in  an  oven  or  over  the  fire.  When  potatoes  cannot  be 
obtained,  a  very  good  hash  may  be  made  by  the  use  of  softened  hard  breaA 
or  boiled  rice  in  their  place. 

Canned  Salt  Beef  Stew 

Cut  up  the  contents  of  a  two-pound  can.  Cover  with  cold  water  and 
bring  to  the  boiling  point.  Then  add  vegetables  as  directed  for  roast-beef 
stew.  Season  with  pepper,  but  add  no  salt.  Stew  for  three-quarters  of  an 
hour. 

Canned  Salt  Beef  Hash 

Two  pounds  (one  can)  of  salt  beef. 

One  cup  of  hard-bread  crumbs. 

One  onion. 

Bacon  fat  or  beef  fat  (about  the  size  of  an  egg). 

Water,  or  soup  stock. 

Pepper  and  salt. 

Chop  up  the  beef.  Add  the  bacon  fat  or  beef  fat,  and  add  sufficient 
water  or  soup  stock  to  moisten  the  whole.  Season  with  pepper  and  a  very 
little  salt.  Parboil  the  onion,  chop  it  up,  and  add  it  to  the  mixture.  Put 
into  a  frying  pan  or  mess  plate  and  brown  on  both  sides.  If  desired,  the 
onion  may  be  fried  before  adding  it  to  the  hash. 

Rice  Pudding 

Two  tablespoonfuls  of  rice. 

One  tablespoonful  of  sugar. 

One  pint  of  fresh  milk. 

Nutmeg  or  cinnamon  as  flavoring. 

Wash  the  rice  and  cover  with  the  milk,  previously  sv/eetened  and  flavored. 
Set  in  a  moderately  hot  oven.  Stir  every  fifteen  minutes  during  the  first 
hour  and  then  once  at  the  expiration  of  the  next  half-hour.  Bake  two  hours 
and  until  the  brown  top  forms.     This  gives  a  creamy,  slightly  brown  pudding. 

Baked  Bean  Soup 

Take  cold  baked  beans,  add  twice  as  much  water  as  beans,  and  let  them 
summer  till  soft.  When  done,  add  half  as  much  canned  tomatoes  and  strain. 
If  too  thick  add  more  water.     Season  to  taste  with  salt  and  pepper. 

Pea-Meal  Soup 

One-half  pound  of  salt  pork  or  bacon. 

One  and  one-half  pints  of  water. 

Two  tablespoonfuls  of  pea-meal. 

Boil  the  bacon  or  pork  in  the  water.  When  the  meat  is  nearly  cooked, 
add  the  pea-meal  and  let  simmer  until  the  meat  is  thoroughly  done.  Skim 
off  the  fat,  season  with  pepper  and  serve.  Canned  salt  meat  can  also  be 
used  to  make  pea  soup,  but  does  not  require  so  long  to  prepare,  as  the  meat 
is  already  cooked.     Season  with  pepper  and  very  little  salt.     Serve  hot. 


APPROXIMATE  MEASURES  285 

Fried  Pea-Meal  Mush 

One  pint  of  water. 

One  teaspoonful  of  salt. 

Four  tablespoonfuls  of  pea  meal. 

Add  the  pea-meal  to  the  salted  water.  Boil  for  twenty  minutes.  Cool 
by  pouring  out  into  a  plate  or  mess  tin.  Slice  and  fry  quickly  in  hot  bacon- 
fat  (for  convalescents). 

Tomato  Soup 

To  one  can  of  tomatoes  add  an  equal  quantity  of  water  and  let  simmer 
for  half  an  hour.  Mix  one  tablespoonful  of  flour  with  an  equal  quantity  of 
beef  dripping  or  bacon  fat.  Add  it  to  the  tomatoes.  Season  with  pepper 
and  salt.  If  very  acid,  a  teaspoonful  of  sugar  may  be  added  to  disguise  the 
acidity.  Boiled  rice  or  hard-bread  crumbs  make  a  very  good  addition  to 
tomato  soup.     Serve  hot. 

Stewed  Tomatoes  with  Hard  Bread 

To  each  can  of  tomatoes  add  half  an  onion  chopped  fine,  salt  and  pepper 
to  taste,  and  if  tomatoes  are  very  acid,  enough  sugar  to  counteract  the  acidity. 
Cover,  and  stew  for  three-quarters  of  an  hour.  Hard-bread  crumbs  are 
added  to  thicken  to  the  consistency  desired. 

Baked  Tom^atoes  with  Hard  Bread 

Mix  enough  hard-bread  crumbs  with  the  canned  tomatoes  to  absorb  the 
greater  portion  of  the  juice;  season  with  salt,  pepper,  and  thin  slices  of 
bacon  laid  on  top,  and  bake  from  three-quarters  of  an  hour  to  an  hour. 
Onions,  either  raw  or  fried,  may  be  chopped  up  and  added  to  the  seasoning. 


APPROXIMATE  MEASURES 

Four  teaspoonfuls  of  liquid  are  equal  to  one  tablespoonful. 
Three  teaspoonfuls  of  solid  material,  as  sugar  or  arrowroot,  are  equal  to 
one  tablespoonful. 

One  tablespoon  contains  one-half  a  fluid  ounce. 

One  coffee  cup,  quartermaster's,  contains  ten  fluid  ounces. 

One  coffee  cup,  usual  size,  contains  eight  fluid  ounces. 

One  glass  tumbler,  usual  size,  contains  eight  fluid  ounces. 

Two  coffee  cups,  or  glass  tumblers,  usual  size,  are  equal  to  one  pint. 

One  tin  cup,  soldier's  field  mess  outfit,  contains  one  and  one-half  pints. 


PART  VI 

MATERIA  MEDICA  AND  THERAPEUTICS,  AND  PHARMACY 


CHAPTER    I 

MATERIA   MEDICA   AND  THERAPEUTICS 

Materia  medica  treats  of  the  materials  or  drugs  used  in  medicine ; 
their  origin,  composition,  physical  and  chemical  properties,  and  their 
action. 

Therapeutics  is  the  art  of  applying  the  articles  of  the  materia 
medica  to  the  cure  of  disease. 

Pharmacy  is  the  art  of  preparing  drugs  and  dispensing  them. 

MATERIA    MEDICA 

Drugs  or  medicines  are  derived  from  the  animal,  vegetable,  and 
mineral  kingdoms. 

The  active  principles  of  drugs  are  those  constituents  which  are 
active  in  producing  the  effects  of  the  drug;  morphine,  for  example,  is 
the  active  principle  of  opium. 

Among  active  principles  are  alkaloids  and  neutral  principles. 

Alkaloids  are  usually  very  insoluble  in  water,  but  combine  with 
acids  to  form  soluble  salts;  they  have  powerful  medicinal  effects; 
their  Latin  names  end  in  ina  and  their  English  names  in  ine;  mor- 
phine, atropine,  and  quinine  are  some  of  the  alkaloids  of  the  supply     / 
table.  , 

Nuetral  principles  are  neutral  in  character ;  they  are  distinguished 
by  having  their  Latin  names  ending  in  inum  and  English  names  end- 
ing in  in.     Among  neutral  principles  of  the  supply  table  is  santonin. 

Organic  acids  are  found  in  organic  substances.  Examples :  acetic 
acid,  citric  acid. 

Mineral  acids  are  obtained  from  the  mineral  kingdom.     Examples : 

(287) 


288    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

sulphuric  acid,  hydrocloric  acid.  They  neutralize  alkalies  and  when 
concentrated  act  as  caustics. 

Alkalies  or  ant-acids  neutralize  acids  and  in  some  forms  act  as 
caustics.     Examples :  bicarbonate  of  soda,  potassa. 

Fixed  oils  are  non-volatile,  and  are  decomposed  by  boiling  with 
water  and  an  alkali,  the  resulting  products  being  soap  and  glycerin. 
Examples:  olive  oil,  castor  oil. 

Volatile  or  essential  oils  exist  in  plants  from  which  they  are  ex- 
tracted by  distillation  with  water;  they  evaporate  when  exposed  to 
the  air  and  have  penetrating  aromatic  odors.  Examples :  oil  of 
cloves,  oil  of  pepermint. 

Medicines  are  sometimes  classified  according  to  their  most  notice- 
able effects,  thus : 

Anodynes  are  remedies  which  relieve  pain.  Examples :  opium, 
acetphenetidin. 

Anesthetics  are  agents  which  temporarily  destroy  sensation;  they 
are  subdivided  into  General  Anesthetics  and  Local  Anesthetics. 

General  anesthetics  are  volatile  substances  whicn,  when  inhaled, 
destroy  consciousness  and  sensation.     Examples :  ether,  chloroform. 

Local  anesthetics  act  directly  upon  the  nerves  of  the  part  with 
which  they  are  brought  in  contact,  destroying  sensation  temporarily. 
Examples :  cocaine,  phenol. 

Anthelmintics  are  agents  used  to  exper worms  from  the  intestines. 
Example :  calomel. 

Antidotes  are  remedies  against  poisons;  thus  the  alkaline  sul- 
phates are  antidotes  for  phenol. 

Antipyretics  are  agents  which  reduce  fever.  Examples :  quinine, 
antipyrin. 

Antiseptics  are  substances  which  prevent  or  retard  septic  decom- 
position by  destroying  or  arresting  the  development  of  the  bacteria  of 
sepsis. 

Astringents,  of  which  alum  is  an  example,  are  substances  which 
couse  a  constriction  of  the  tissues. 

Carminatives  are  agents  which  cause  the  expulsion  of  gas;  the 
essential  oils  are  carminatives. 

Cathartics,  purgatives,  and  laxatives  are  medicines  which  increase 
the  action  of  the  bowels ;  rochelle  salts  is  an  example. 

Diaphoretics  are  agents  which  increase  the  secretion  of  sweat. 
Dover's  powder  is  a  diaphoretic. 


MATERIA  MEDICA  AND  THERAPEUTICS         289 

Disinfectants  are  substances  which  destroy  the  specific  germs 
which  infect  people  with  disease.  Phenol  and  corrosive  sublimate 
are  disinfectants. 

Diuretics  increase  the  flow  of  urine.  Example :  sweet  spirits  of 
niter. 

Emetics  cause  vomiting.     Ipecac  and  apomorphine  are  emetics. 

Expectorants  are  agents  which  aid  expectoration.  Ammonium 
chloride  is  an  expectorant. 

Hypnotics  produce  sleep.    Veronal  and  chloral  are  hypnotics. 

Narcotics  are  agents  which  produce  stupor.     Example :  opium. 

Styptics  are  substances  which  arrest  bleeding.    Alum  is  a  styptic. 

Certain  drugs  aflfect  the  skin,  urine,  or  feces  in  a  way  that  should 
be  known  to  those  charged  with  their  administration : 

Drugs  which  may  produce  an  eruption  on  the  skin:  Arsenic, 
acetanilid,  antipyrin,  belladonna,  bromides,  chloral,  copaiba,  iodides, 
opium,  acetphenetidin,  quinine,  salicylic  acid,  turpentine. 

Drugs  which  color  the  feces:  Iron — black;  bismuth — slate  color 
or  black ;  calomel — green. 

Drugs  which  color  the  urine:  Carbolic  acid — dark  green;  rhu- 
barb— yellow ;  santonin — saffron  color  if  the  urine  is  acid,  purplish- 
red  if  alkaline. 

Drugs  which  have  a  tendency  to  become  liquid  on  exposure  to  air, 
by  the  absorption  of  moisture,  are  said  to  be  deliquescent  or  hygro- 
scopic, while  those  which  lose  their  water  of  crystallization  and 
become  dry  and  powdery  are  called  efflorescent. 

ADMINISTRATION    OF    MEDICINES 

Medicines  are  given  by  the  mouth  and  stomach,  by  the  rectum,  by 
the  skin,  blood-vessels,  and  subcutaneous  cellular  tissues. 

By  the  mouth  and  stomach  is  the  method  ordinarily  employed. 
Medicines  which  are  irritating  to  the  stomach  should  be  given  well 
diluted  and  after  meals. 

The  rectum  is  sometimes  employed  for  the  administration  of 
medicine  when  the  stomach  will  not  retain  them. 

Remedies  are  injected  into  the  veins  direct  only  in  case  of  great 
emergency. 

The  administration  of  drugs  by  the  subcutaneous  cellular  tissue  is 
called  the  hypodermic  method;  it  is  employed  when  prompt  action  is 
desired.  Alkaloids  like  morphine  and  strychnine  are  especially  suit- 
19 


290    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

able  for  this  method,  and  large  quantities  of  normal  salt  solution  are 
frequently  so  employed. 

Substances  are  also  introduced  into  the  circulation  by  simply  rub- 
bing them  into  the  unbroken  skin.  Fats  and  oils  and  remedies  in- 
corporated with  them  are  often  used  in  this  way.  Syphilis  is  fre- 
quently treated  by  inunctions  of  mercurial  ointment.  • 

DOSAGE 

Doses  are  only  relative  and  cannot  be  represented  in  exact  figures, 
since  they  are  subject  to  so  many  influencing  circumstances.  The 
principal  of  these  are  age,  size  and  weight,  habit,  idiosyncrasy,  in- 
terval between  doses,  time  of  administration,  condition  of  stomach 
or  (if  externally  applied)  of  skin,  disease,  clirtiate,  method  of 
administration,  form  of  drug  used,  etc. 

Dosage  in  children:  Doses  ordinarily  given  are  those  for  adults; 
to  compute  the  suitable  quantity  for  a  child,  either  of  the  following 
rules  may  be  made  use  of : 

( 1 )  Young's  method :  Divide  the  age  by  the  age  +  12 ;  thus,  sup- 
pose the  child  is  3  years  old  j^^=Ji^^=i  :  hence  we  give  one-fifth 
of  the  adult  dose. 

(2)  Cowling's  method :  Divide  the  number  of  the  following  birth- 
day by  24;  thus,  child's  age  is  3,  next  birthday  is  ^=1  :  hence 
dose  is  one-sixth  that  of  adult  (this  gives  a  slightly  smaller  dose 
than  does  Young's  rule). 

Children  bear  opium  badly,  and  hence  the  dose  should  be  propor- 
tionately small.  Comparatively  large  doses  of  belladonna,  jaborandi, 
aconite,  mercury,  arsenic,  quinine,  and  cathartics  in  general  are  borne 
by  children. 

When  given  hypodermically,  the  dose  of  medicines  is  two-thirds 
of  that  used  by  mouth.  When  given  by  rectum,  it  is  four-thirds  of 
the  dose  by  mouth. 

MEDICINES   AND    MEDICAL   AGENTS   OF   THE  ARMY  AND    NAVY 
SUPPLY   TABLES 

Acacia  (Gum  Arabic).  A  gummy  exudation  from  Acacia  Senegal 
and  other  species  of  Acacia.  A  glassy-looking  substance  in  frag- 
ments ;  insipid  taste,  soluble  in  water,  used  as  a  vehicle.  The  pow- 
der is  white. 

Mucilago  Acaciae  (acacia  340;  lime  water  330;  water  to  1,000). 


MATERIA  MEDICA  AND  THERAPEUTICS  291 

Acetanilidum  (Acetanilid),  A  derivative  of  aniline.  A  colorless 
crystalline  powder,  odorless,  with  a  slightly  burning  taste,  soluble  in 
179  parts  water.     Used  in  neuralgia. 

Dose :   ^  Gm. 

Acetphenetidinum  (Acetphenetidin.  Phenacetin).  A  phenol  de- 
rivative. White  scales  or  crystalline  powder,  odorless  and  tasteless. 
Soluble  in  925  parts  of  water  or  12  parts  of  alcohol.  Antipyretic  and 
antineuralgic.  Dose :    |  Gm. 

Acidum  Aceticum  (Acetic  Acid).  A  clear,  colorless  liquid,  hav- 
ing a  strong  vinegar-like  odor  and  an  acid  taste 

Acidum  Aceticum  Dilutum  (acetic  acid  100;  water  500). 

Dose :    2  Cc. 

Acidum  Boricum  (Boric  Acid).  Colorless  scales  or  a  light  white 
powder;  odorless  and  slightly  bitter.  Soluble  in  18  parts  of  water. 
Used  as  a  mild  antiseptic.     Dose :    -J  Gm. 

Acidum  Citricum  (Citric  Acid).  Usually  prepared  from  lime  or 
lemon  juice.  Colorless,  odorless,  acid-tasting  crystals;  efflorescent 
in  dry  air  and  deliquescent  in  moist  air;  soluble  in  0.54  part  water. 

Dose :   ^  Gm. 

Acidum  Gallicum  (Gallic  Acid).  An  organic  acid  usually  pre- 
pared from  tannic  acid.  Fawn-colored  needles,  astringent,  slightly 
acid,  permanent.     Soluble  in  83.7  parts  water  and  4.14  alcohol. 

Used  as  an  astringent.     Dose :    ^  Gm. 

Acidum  Hydrochloricum  (Hydrochloric  Acid).  A  colorless, 
fuming  liquid  which  should  be  kept  in  glass-stoppered  bottles. 

Acidum  Hydrochloricum  Dilutum  (Hydrochloric  acid  100,  water 
219).  Dose:    i  Cc. 

Acidum  Hydrocyanicum  Dilutum  (Dilute  Hydrocyanic  Acid; 
Dilute  Prussic  Acid).  A  colorless  liquid  containing  2  per  cent  of 
absolute  hydrocyanic  acid,  and  having  the  odor  of  bitter  almonds. 
As  it  is  very  poisonous,  it  should  not  be  tasted  except  with  great 
caution.  Should  be  kept  in  dark  amber-colored  bottles  in  a  cool 
place.  Dose:    o.i  Cc. 

Acidum  Nitricum  (Nitric  Acid).  A  colorless,  fuming  liqijid; 
very  caustic ;   should  be  kept  in  glass  stoppered  bottles. 

Acidum  Nitricum  Dilutum  (nitric  acid  100,  water  580). 

Dose :    2  Cc. 

Acidum  Oxalicum  (Oxalic  Aid).  Colorless  crystals,  very  poi- 
sonous.    Surgical  use,  externally  only.     Fatal  results  have  followed 


292    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

mistaking  this  substance  for  sulphate  of  magnesia,  which  it  resem- 
bles. The  two  may  be  distinguished  by  heating  a  few  of  the 
crystals  to  a  red  heat  on  the  end  of  a  spatula;  oxalic  acid  will  be 
completely  dissipated,  while  sulphate  of  magnesia  will  not.  An- 
other distinction  lies  in  the  fact  that  oxalic  acid  decolorizes  solution 
of  permanganate  of  potash,  while  sulphate  of  magnesia  does  not. 

Acidum  Phosphoricum  Dilutum  (Dilute  Phosphoric  Acid).  A 
colorless,  odorless  liquid,  which  should  be  kept  in  glass-stoppered 
bottles.     (Phosphoric  acid  lOO,  water  750). 

Dose :    2  Cc. 

Acidum  Salicylicum  (Salicylic  Acid).  An  organic  acid  existing 
naturally  in  some  plants,  but  generally  prepared  from  phenol.  Light, 
fine,  white  needles,  or  a  crystalline  powder,  with  a  faint  odor  and 
sweetish  taste.  Soluble  in  308  parts  water.  Used  in  rheumatic 
troubles.  Dose :    ^  Gm, 

Acidum  Sulphuricum  (Sulphuric  Acid).  A  colorless,  oily,  very 
corrosive  liquid.     Should  be  kept  in  glass-stoppered  bottles. 

Acidum  Sulphuricum  Aromaticum  (Aromatic  Sulphuric  Acid). 
Sulphuric  acid  iii,  tincture  of  ginger  50,  oil  of  cinnamon  i,  alcohol 
to  1,000.)  Dose:    i  Cc. 

Acidum  Tannicum  (Tannic  Acid).  An  organic  acid  obtained 
from  nutgalls.  A  light  yellow  powder  with  a  faint  odor,  and 
strongly  astringent  taste.  Soluble  in  about  0.34  part  of  water.  Used 
as  an  astringent.  Dose :    ^  Gm. 

Acidum  Tartaricum  (Tartaric  Acid).  An  organic  acid  occurring 
in  colorless  crystals  or  a  white  powder;  odorless  and  with  an  acid 
taste;   soluble  in  0.71  part  of  water. 

Dose:  ^  Gm. 

Aconiti  Tinctura  (Tincture  of  Aconite).  10  per  cent  strength. 
Used  to  quiet  the  heart.       Dose :    ^  Cc. 

Adeps  Benzoinatus  (Benzoinated  Lard).  (Benzoin  20,  lard 
1,000;  in  warm  weather  substitute  5  per  cent  of  the  lard  by  an  equal 
quantity  of  white  wax).     Used  as  a  basis  for  ointments. 

Adeps  Lance  Hydrosus  (Wool-Fat.  Lanolin).  The  purified  fat 
of  the  wool  of  sheep,  freed  from  water.  A  light-yellowish,  tena- 
cious, unctuous  mass ;  insoluble  in,  but  miscible  with  large  quantities 
of  water.     Used  as  a  basis  for  ointments. 

Adrenalini  Chloridum  (Adrenalin  Chloride).  An  active  principal 
obtained  from  the  adrenal  glands. 


MATERIA  MEDICA  AND  THERAPEUTICS         293 

Used  locally  to  control  bleeding  from  the  nose  and  throat. 

JEther  (Ether).  A  transparent,  colorless  liquid,  having  a  char- 
acteristic odor  and  a  burning  sweetish  taste.  Its  vapor  v^hen  mixed 
with  air  and  ignited  explodes  violently. 

Used  chiefly  as  an  anesthetic,  by  inhalation. 
Dose  internally  i  Cc, 

Athens  Spiritus  Compositus  (Compound  Spirits  of  Ether.  Hoff- 
man's Anodyne).      (Ether  325,  alcohol  650,  ethereal  oil  25.) 

Used  as  a  stimulant  and  carminative. 

Dose :    4  Cc. 

Mtheris  Spiritus  Nitrosi  (Spirits  of  Nitrous  Ether.  Sweet 
Spirits  of  Niter).  A  clear,  volatile  liquid  of  a  pale  yellowish  tint, 
fragrant  odor  and  burning  taste.  Used  as  a  diuretic  and  carmina- 
tive. Dose :    2  Cc. 

^thylis  Chloridum  (Ethyl  Chloride).  An  extremely  volatile 
liquid  kept  in  hermetically  sealed  glass  tubes. 

Used  chiefly  in  the  form  of  a  spray  as  a  local  anesthetic  by  virtue 
of  its  freezing  properties.  Also  sometimes  used  as  a  general  anes- 
thetic by  inhalation. 

Alcohol  (Alcohol).  A  colorless  volatile  liquid  containing  about 
95  per  cent  by  volume  of  absolute  alcohol.  It  is  obtained  by  the 
distillation  of  grain. 

Alcohol,  Methyl  (Wood  Alcohol).  A  colorless,  poisonous  liquid 
of  a  disagreeable  odor  obtained  in  the  destructive  distillation  of 
wood.  It  is  used  as  an  adulterant  in  cheap  liquors  and  toilet  prep- 
arations and  as  fuel,  and  when  taken  internally  has  caused  many 
deaths. 

Aloe  (Aloes).  The  inspissated  juice  of  the  leaves  of  Aloe  vera 
and  other  species  of  Aloe. 

Aloe  Pulvis  (Powdered  Aloes).  A  brownish-yellow  powder  of 
bitter  taste,  used  as  a  laxative. 

Dose :   ^  Gni. 

Aloini  Piluloe  Composites  (Compound  Aloin  Pills).  Contain  8 
mgm.  each  of  aloin,  podophyllum  resin,  and  extract  of  belladonna, 
0.8  mgm.  of  strychnine,  and  2.7  mgm.  of  oleoresin  of  capsicum. 

Dose:    1-2  pills. 

Alumen  (Alum).  The  powder  is  white,  with  a  sweet,  astringent 
taste ;  soluble  in  9  parts  water. 

Used  as  an  emetic  and  as  an  astringent. 

Dose:   ^  Cm. 


294    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Ammonice  Aqua  (Ammonia  Water).  A  lo  per  cent  aqueous 
solution  of  ammonia  gas.  A  colorless,  volatile  liquid,  which  deteri- 
orates on  keeping ;  should  be  kept  in  glass-stoppered  bottles  in  a  cool 
place. 

A  powerful  stimulant. 

Dose :    i  Cc.  well  diluted. 

Ammonice  Spiritus  Arotnatictis  (Aromatic  Spirits  of  Ammonia). 
(Ammonium  carbonate  34,  ammonia  water  90,  alcohol  700,  aromat- 
ics  q.  s.,  water  to  1,000.)     A  yellowish  liquid  used  as  a  stimulant. 
Dose :    2  Cc.  well  diluted. 

Ammonii  Bromidum  (Ammonium  Bromide).  Colorless  crystals 
or  a  white  crystalline  powder,  odorless  and  of  saline  taste;  soluble 
in  1.2  parts  of  water;  irritating  to  the  stomach;  should  be  adminis- 
tered in  plenty  of  water. 

Used  as  a  sedative.  Dose :    i  Gm. 

Ammonii  Carhonas  (Ammonium  Carbonate).  White,  translucent 
or  opaque  masses,  having  a  strong  odor  of  ammonia.  Only  the 
translucent  portions  should  be  dispensed. 

Used  as  a  stimulant.        Dose:    |  Gm. 

Ammonii  Chloridum  (Ammonium  Chloride).  A  white,  odorless 
powder,  with  a  cooling  taste. 

Used  as  an  expectorant.    Dose  :    ^  Gm. 

Ammonii  Chloridi  Trochisci  (Ammonium  Chloride  Troches). 
Each  contains  130  mgms.  ammonium  chloride  and  |  gm.  extract  of 
licorice.  Dose :    i  lozenge. 

Amylis  Nitris  (xA.myl  Nitrite).  A  clear,  yellow  liquid  of  a  pecu- 
liar, penetrating  odor.  A  powerful  stimulant,  used  by  inhalaton 
only.  Dose :    0.2  Cc. 

Antimonii  et  Potassii  Tartras  (Tartar  Emetic).  Colorless  crys- 
tals or  a  white  granular  powder ;  odorless  and  with  a  sweetish  taste. 
Soluble  in  15.5  parts  of  water. 

Dose :  as  an  expectorant,  5  milligrammes ;  as  an  emetic, 
30  milligrammes. 

Antipyrinum  (Antipyrin).  A  colorless,  almost  odorless,  crystal- 
line powder  obtained  from  coal  tar,  having  a  bitter  taste ;  soluble  in 
less  than  i  part  of  water.     Dose :   ^  Gm. 

ApomorphincE  Hydro  chloridum  (Apomorphine  Hydrochloride). 
The  salt  of  an  alkaloid  derived  from  opium.     White  crystals  acquir- 


MATERIA  MEDICA  AND  THERAPEUTICS  295 

ing  a  greenish  tint  after  exposure  to  light.     Used  hypodermically  as 
an  emetic.  Dose :    5  milhgrammes. 

Aqiia  Hydrogenii  Dioxidi  (Solution  of  Hydrogen  Dioxide. 
Peroxide).  (10  per  cent  by  volume.)  A  colorless,  odorless  liquid 
rapidly  deteriorating  upon  exposure.  Used  chiefly  externally  to 
cleanse  suppurating  wounds. 

Argenti  Nitras  (Silver  Nitrate).  Colorless  crystals,  soluble  in 
0.54  part  of  water,  and  decomposed  by  light. 

Used  externally  prncipally. 

Dose:    10  milligrammes. 

Argenti  Nitras  Fusus  (Lunar  Caustic).  White  or  gray  pencils. 
External  use. 

Argyrol.  A  proteid  silver  salt,  occurring  in  black  hygroscopic 
scales,  containing  30  per  cent  metallic  silver.  Soluble  in  all  propor- 
tions in  water.  Used  chiefly  locally  in  inflammation  of  mucous 
membranes,  and  in  20-50  per  cent  solution. 

Dose:   ^  Gm. 

Arseni  et  Hydrargyri  lodidi  Liquor  (Solution  of  Arsenous  and 
Mercuric  Iodides).  (Donovan's  Solution.)  Used  in  skin  diseases 
and  syphilis.  Dose :    i-io  Cc. 

Arseni  Trioxidum  (White  Arsenic.  The  Acidum  Arsenosum  of 
1890).  An  opaque,  white,  poisonous  powder;  odorless  and  taste- 
less.    Soluble  in  about  100  parts  of  water. 

Dose :    2  milligrammes. 

Asafetida  (Asafetida).  A  gum-resin  from  the  root  of  Ferula 
fcetida  and  other  species  of  Ferula.     Yellowish-white  masses. 

Dose :   ^  Gm. 

Aspidii  Oleoresince  (Oleoresin  Aspidium).  A  thick,  dark-green 
liquid,  depositing  a  granular  substance  on  standing;  this  granular 
part  should  be  well  mixed  with  the  liquid  portion  before  dispensing. 
Used  especially  against  tape-worms. 

Dose :    2  Gms. 

Aspirin.  A  salicylic  acid  compound.  Colorless  crystals  not  very 
soluble  in  water;  readily  soluble  in  alcohol.  Used  as  a  substitute 
for  salicylic  acid.  Dose  :   ^  to  i  Gm. 

Atropines  Sulphas  (Sulphate  of  Atropine).  The  sulphate  of  an 
alkaloid  obtained  from  Atropa  Belladonna  and  other  plants  of  the 
same  family.     A  white,  odorless,  bitter  powder ;  very  poisonous. 

Used  especially  to  dilate  the  pupil. 

Dose :   0.4  milligramme. 


296    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Balsamiim   Peruvianum    (Balsam   of    Peru).      A   viscid,    dark- 
brown  liquid,  of  agreeable  odor.     Used  as  a  wound  dressing. 
Balsamum  Tolutanum  (Balsam  of  Tolu). 
Bclladonncv  Emplastrum  (Belladonna  Plaster). 
Belladonna  Foliorum  Extractum  (Extract  of  Belladonna  Leaves). 
Used  cbiefly  externally. 

Dose:    lo milligrammes. 
Bcnzoini  Tinctura  Composita  (Compound  Tincture  of  Benzoin). 
Used  chiefly  by  inhalation  with  the  vapor  of  hot  water. 

Dose :    4  Cc. 
Bismuthi  Suhgallas  {^\s>m\i\h.S\xhg3.\\2i\.t.     Dermatol).     An  amor- 
phous, yellow  powder,  insoluble  in  water,  odorless  and  tasteless; 
colors  the  stools  black.     Used  in  diarrheal  diseases. 

Dose:    ^  Gm. 
Bismuthi  Subnitras    (Bismuth   Subnitrate).      A   white  powder, 
odorless,  tasteless,  and  insoluble  in  water.     Used  in  diarrheal  dis- 
eases.    Colors  the  stools  black. 

Dose :   ^  Gm. 
Buchu  Fluidextractum    (Fluidextract  of   Buchu).     A  greenish- 
black  liquid.     Used  as  a  diuretic. 

Dose :    2  Cc. 
Caffeina  Citrata  (Citrated  Caffeine).       A  white,  odorless,  bitter 
powder.     Used  as  a  diuretic  and  heart  stimulant. 

Dose :    ^  Gm. 
Calcii  Phosphas  Prcccipitatus  (Precipitated   Phosphate   of   Cal- 
cium).    An  amorphous,  white  powder,  insoluble,  odorless,  tasteless, 
and  permanent.     Used  chiefly  in  tuberculosis. 

Dose:    i  Gm. 

Calx  (Lime).     Hard  white  or  grayish-white  masses.     Soluble  in 

760  parts  of  water.    Slakes  in  the  air.    Used  to  prepare  lime  water. 

Calx  Chlorinata  (Chlorinated  Lime).     A  white  powder  with  the 

odor  of  chlorine,  and  decomposing  on  exposure  to  air.     Used  as  a 

disinfectant.  Dose:    ^  Gm. 

Camphora  (Camphor).  White  masses,  sparingly  soluble  in 
water,  but  readily  soluble  in  alcohol  and  in  oils.  Used  principally 
externally.  Dose :    |  Gm. 

Camphorce  et  Opii  Pilulce  (Camphor  and  Opium  Pills).  Each 
pill  contains  65  mgms.  opium  and  130  mgms.  camphor. 

Dose:    i  pill. 


MATERIA  MEDICA  AND  THERAPEUTICS  297 

Cantharidis  Emplastrum  (Cantharidis  Plaster.  Blistering  Plaster). 

Cantharidis  Tinctura   (Tincture  of   Cantharides).     An  alcoholic 
extract  of  powdered  Spanish  Flies.    Used  chiefly  externally. 
Dose  :    ^  Cc.  well  diluted. 

Capsici  Pulvis  (Powdered  Capsicum.  Red  Pepper).  A  red 
powder.  Dose :    65  milligrammes. 

Capsici  Tinctura  (Tincture  of  Capsicum).  Used  chiefly  exter- 
nally. Dose  :    ^  Cc.  well  diluted. 

Capsici  Fluidextractum  (Fluidextract  of  Capsicum).  Used  in  the 
same  manner  as  the  tincture. 

Dose:    0.05  Cc. 

Cardamomi  Tinctura  Composita  (Compound  Tincture  of  Car- 
damomum).     Used  chiefly  as  a  bitter  tonic. 

Dose :    4  Cc. 

Cera  Flava  (Yellow  Wax). 

Ceratum  Resincc  (Rosin  Cerate.  Basilicon  Ointment).  (Rosin 
350,  yellow  wax  150,  lard  500).     External  use. 

Chloralum  Hydratum  (Hydrated  Chloral.     Chloral.)      Colorless, 
transparent   crystals,   with   an    aromatic   odor   and   bitterish   taste. 
Freely  soluble  in  water  and  alcohol.     Used  as  a  hypnotic. 
Dose :  i  Gm.  dissolved  in  water  or  whisky. 

Chloroformum  (Chloroform).  A  clear,  colorless  liquid  of  char- 
acteristic odor  and  sweetish,  burning  taste.  Should  be  kept  in  amber- 
colored,  glass-stoppered  bottles  in  a  cool,  dark  place.  Used  chiefly  as 
an  anesthetic  by  inhalation.     Dose :  ^  Cc. 

Chromil  Trioxidum  (Chromium  Trioxide.  Chromic  Acid). 
Should  be  kept  in  glass-stoppered  bottles  and  great  care  taken  not  to 
bring  it  in  contact  with  organic  substances  such  as  cork,  sugar,  alco- 
hol, etc.,  as  an  explosion  may  result.  Needle-shaped  crystals  of 
purplish-red  color;  corrosive,  deliquescent,  very  soluble  in  water. 
Used  solely  as  a  caustic  in  crystals  or  solution. 

Chrysarobinum    (Chrysarobin).     A   neutral   principle   extracted 
from  goa  powder.    An  orange-yellow,  crystalline  powder,  odorless, 
tasteless,  and  very  insoluble.    Used  externally. 
Dose :  30  milligrammes. 

Cinchonce  Tinctura  Composita  (Compound  Tincture  of  Cinchona). 
Used  as  a  tonic  and  in  malarial  diseases. 

Dose :  4  Cc. 

Cocaine  Hydrochloridum   (Cocaine  Hydvochloride).     A   salt  of 


298    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

an  alkaloid  obtained  from  several  species  of  coca.    A  colorless,  odor- 
less, crystalline  powder ;  soluble  in  0.4  part  water. 

Used  chiefly  as  a  local  anesthetic. 

Dose :  32  milligrammes. 

Codeincc  Sulphas  (Codeine  Sulphate).  A  salt  of  an  alkaloid  from 
opium.  A  crystalline  powder,  odorless,  with  a  faintly  bitter  taste. 
Used  as  a  sedative.     Dose:  30 milligrammes. 

Colchici  Seminis  Fluidextr actum  (Fluidextract  of  Colchicum 
Seed).     Used  chiefly  in  gout. 

Dose :  ^  Cc.  well  diluted. 

Collodium  (Collodion).  A  colorless,  syrupy  liquid,  with  the  odor 
of  ether.     Used  externally  only. 

Collodium  Cantharidatum  (Cantharidal  Collodion).  Cantharides 
60,  flexible  collodion  85,  chloroform  to  100. 

Used  externally  to  blister. 

Collodium  Flexile  (Flexible  Collodion).  Collodion  930,  Canada 
turpentine  50,  castor  oil  30. 

Capaiba  (Copaiba).  An  oleoresin  of  a  yellowish  color,  more  or 
less  transparent,  viscid,  having  a  peculiar  aromatic  odor. 

Used  chiefly  in  gonorrhea. 

Dose :  i  Cc. 

Copaiba  Pilulce  Compositce  (Compound  Copaiba  Pills).  Each 
contains  100  mgms.  copaiba  with  guaiac,  iron,  and  cubebs. 

Dose :  i  pill. 

Creosotal  (Creosote  Carbonate).  Contains  90  per  cent  creosote. 
A  thick,  oily,  amber-colored  liquid,  with  but  little  taste  or  odor.  In- 
soluble in  water ;  soluble  in  95  per  cent  alcohol  and  in  oils.  Use  and 
does  the  same  as  creosote. 

Creosotum  (Creosote).  A  mixture  of  phenols  and  phenol  deriva- 
tives obtained  by  the  distillation  of  wood  tar,  preferably  from  the 
beech.  A  yellowish,  oily  liquid  having  a  penetrating,  smoky  odor 
and  a  burning  taste. 

Used  principally  in  phthisis. 

Dose :  ^  Cc. 

Cresol  (Cresol.  Tricresol).  A  mixture  of  three  cresols  obtained 
from  coal  tar.  A  straw-colored  liquid,  having  a  phenol-like  odor. 
Soluble  in  60  parts  of  water. 

Used  externally  as  a  disinfectant. 

Dose :  0.05  Cc. 


MATERIA  MEDICA  AND  THERAPEUTICS         299 

Cresolis  Liquor  Compositus  (Compound  Solution  of  Cresol).     A 
50  per  cent  solution  of  cresol  with  35  per  cent  linseed  oil  and  8 
per  cent  caustic  potash  in  water. 
Used  externally  as  a  disinfectant. 

Creta  Prcuparata  (Prepared  Chalk).     A  white  powder;  odorless, 
tasteless,  insoluble,  permanent. 
Used  in  diarrheal  troubles. 

Dose :  i  Gni. 
CuhehcB  Oleorasina  (Oleoresin  of  Cubeb).     Used  in  gonorrhea. 

Dose :   |  Gm. 
Cupri  Arsenis  (Arsenite  of  Copper). 

Dose :  0.65  milligramme. 
Cupri  Sulphas  (Sulphate  of  Copper).     Deep-blue  crystals,  odor- 
less, efflorescent,  soluble  in  2.2  parts  of  water.    Used  as  an  astringent. 
Dose :   10  milligrammes. 
Digitalinum    (Digitalin).     A  glucoside,   and   active  principle   of 
digitalis.  Dose :   i  milligramme. 

Digitalis  Tinctura  (Tincture  of  Digitalis).    Used  as  a  heart  tonic. 

Dose :  i  Cc. 
Ernestini  Hydrochloridum  (Ernstine  Hydrochloride).     An  alka- 
loidal  salt  obtained  from  ipecac. 

Dose :  30-60  milligrammes. 
Ergotce  Fluidextr actum  (Fluidextract  of  Ergot).     Used  chiefly  to 
control  bleeding.  Dose :  2  Cc. 

Ergotinum  (Ergotin).    An  unofficial  extract  of  ergot. 

Dose:   130  milligrammes. 
Eucaine  Hydrochloridum-B .    A  synthetic  preparation  closely  re- 
sembling cocaine,  for  which  it  is  often  used  as  a  substitute  in  the 
production  of  local  anesthesia. 

Dose :  30  milligrammes. 
Eucalyptol  (Eucalyptol).     An  oxide  from  the  oil  of  eucalyptus. 
A  colorless  liquid  of  aromatic  odor  and  pungent  taste. 

Dose :  i  Cc. 
Ferri  Chloridi  Tinctura  (Tincture  of  Ferric  Cloride).     A  bright, 
brownish  liquid,  having  an  astringent,  styptic  taste.     Injures  the 
teeth ;  should  be  taken  through  a  glass  tube  and  well  diluted.     Used 
as  a  tonic.  Dose :  .|  Cc. 

Ferri  et   Quinincu   Citras  Solubilis   (Soluble   Iron   and   Quinine 


300    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Citrate).     Thin,  greenish,  odorless,  dehquescent  scales;   completely 
soluble  in  water,  partly  soluble  in  alcohol.     Used  as  a  tonic. 

Dose:   ^  Gm. 

Ferri  lodidi  Syrupus  (Syrup  of  Ferrous  Iodide).  A  syrupy,  pale- 
green  liquid,  having  a  sweet  taste.     Used  as  a  tonic. 

Dose :  i  Cc. 

Ferri  Pilulcu  Compositce  (Compound  Iron  Pills).  Each  contains 
65  mgms.  pyrophosphate  of  iron,  32  mgms.  sulphate  of  quinine,  and 
I  mgm.  sulphate  of  strychnine. 

Dose:  1-2  pills. 

Ferri  Phosphas  Soluhilis  (Soluble  Ferric  Phosphate).  Thin, 
apple-green,  colorless  scales;  decomposed  by  light;  soluble  in  water, 
insoluble  in  alcohol.     Used  as  a  tonic. 

Dose :   ^  Gm. 

Ferri  Sulphas  Exsiccatus  (Dried  Ferrous  Sulphate).     A  grayish- 
white  powder,  slowly  but  completely  soluble  in  water. 
Dose :  125  milligrammes. 

Ferrum  Reductum  (Reduced  Iron).  A  fine,  grayish-black  pow- 
der; odorless,  tasteless,  insoluble. 

Dose :  65  milligrammes. 

Foot  Poivdcr.  Contains  3  parts  salicylic  acid,  10  of  starch,  and 
87  of  talcum. 

Gentians  Tinctura  Composita  (Compound  Tincture  of  Gentian). 
Used  as  a  tonic.  Dose :  4  Cc. 

Glycerilis  Nitralis  Tabellce  (Nitroglycerin  Tablets).  Heart  stim- 
ulant.          Dose :   One  tablet  containing  0.65  milligramme. 

Glycerinum  (Glycerin).  A  liquid  obtained  by  the  decomposition 
of  fats  or  fixed  oils;  clear,  colorless,  odorless,  sweet.  Used  exter- 
nally. Dose :  4  Cc. 

Glycyrrhizce  Extractum  Puram  (Pnlvis)  (Pure  Extract  of  Lico- 
rice).    A  brown  powder  used  for  flavoring. 

Glycyrrhizce  Mistura  Composita  (Compound  Licorice  Mixture. 
Brown  Mixture).  Contains  paregoric,  wine  of  antimony,  sweet 
spirits  of  niter,  licorice,  gum  arable,  syrup  and  water.  Eight  Cc. 
contains  about  i  Cc.  of  paregoric  and  ^  Cc.  of  sweet  spirits  of  niter. 
Used  as  cough  mixture.       Dose  :  8  Cc. 

Glycyrrhisce  Pulvis  Compositus   (Compound  Licorice  Powder). 


MATERIA  MEDICA  AND  THERAPEUTICS         301 

Contains  senna,  sulphur,  licorice,  oil  of  fennel,  and  sugar;  about  f 
Gm.  of  senna  and  ^  Gm.  of  sulphur  in  each  4  Gms.  Used  as  a  laxa- 
tive. Dose :  4  Gms. 

Guaiaci  Tinctura  Ammoniata  (Ammoniated  Tincture  of  Guaiac). 
Used  especially  in  tonsillitis. 

Dose :  2  Cc. 
Guaiacolis  Carbonas    (Guaiacol  Carbonate).     One  of   the   chief 
constituents  of  creosote.     A  white  powder,  almost  tasteless  and  odor- 
less; insoluble  in  water.     Used  in  tuberculosis. 

Dose :  i  Gm. 

Hamamelidis  FoUorum  Fluidextr actum  (Fluidextract  of  Ham- 
emelis  Leaves.     (Witch  Hazel).     Used  chiefly  externally. 

Dose :  2  Cc. 
Heroini  Hydrochloridum  (Heroin  Hydrochloride).     A  morphine 
derivative.      Used    chiefly    to    control    cough,      A    white    powder, 
soluble  in  water. 

Dose :    5  milligrammes. 
Hexamethylenamina   (Hexamethylenamine.     Urotropin).    Color- 
less, odorless  crystals;  soluble  in  1.5  parts  of  water  and  10  parts 
alcohol.     Used  as  a  urinary  disinfectant. 

Dose :   ^  Gm. 
Homatrophince  Hydrohromidum   (Homatropine  Hydrobromide). 
An  artificial  alkaloid  derived  from  atropine.     Used  to  dilate  the 
pupil.    Soluble  in  10  parts  of  water. 

Hydrargyri  Chloridum  Corrosivum  (Corrosive  Chloride  of  Mer- 
cury. Corrosive  Sublimate).  Colorless,  odorless,  permanent  crys- 
tals, soluble  in  13  parts  of  water,  3  parts  of  alcohol.  Used  as  an 
antiseptic  and  in  syphilis. 

Dose :  3  milligrammes,  dissolved  in  abundance  of  water. 
Hydrargyri  Chloridum  Mite  (Mild  Mercurous  Chloride.     Calo- 
mel).    A  white  powder,   insoluble,  odorless,  tasteless,  permanent. 
Used  as  a  laxative  and  in  syphilis. 

Dose:  65-215  milligrammes. 

Hydrargyri  lodidiim  Flavum  (Yellow  Mercurous  Iodide).  A 
bright  yellow  powder,  odorless,  tasteless,  insoluble;  decomposed  by 
exposure  to  air.     Used  in  syphilis. 

Dose :  10  milligrammes, 


302    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Hydrargyri  Massa  (Mass  of  Mercury.  Blue  Mass).  A  blue 
mass.    Used  as  a  laxative  and  in  syphilis. 

Dose :   ^  Gm. 

Hydrargyri  Nitratis  Unguentiim  (Ointment  of  Mercuric  Nitrarte. 
Citrine  Ointment).    A  bright  yellow  ointment.    Used  externally. 

Hydrargyri  Oleatum  (Oleate  of  Mercury).  A  thick,  yellowish 
liquid.    Used  externally. 

Hydrargyri  Oxidum  Flavum  (Yellow  Mercurous  Oxide).  A 
light  orange-yellow  powder;  insoluble  in  water  or  alcohol.  Used 
externally. 

Hydrargyri  Salicylas  (Salicylate  of  Mercury). 

Hydrargyri  Unguentum  (Mercurial  Ointment.  Blue  Ointment). 
A  blue  ointment.     Used  externally  in  syphilis. 

Hydrastis  Fluidextractum  (Fluidextract  of  Hydrastis).  Used  in 
coughs.  Dose :  2  Cc. 

Hyoscince  Hydrohromidum  (Hyoscine  Hydrobromide).    The  salt 
of  an  alkaloid  obtained  from  hyoscyamus  or  henbane.     Colorless, 
odorless  crystals;  soluble  in  1.5  parts  of  water.     Used  as  a  sedative. 
Dose :  ^  milligramme. 

Hyoscyami  Extractum  (Extract  of  Hyoscyamus).  Used  as  a 
sedative.  Dose  :  65  milligrammes. 

Hyoscyami  Pilulce  Composiice  (Compound  Pills  of  Hyoscyamus). 
Each  contains  65  mgms.  each  of  extract  of  hyoscyamus  and  of  cam- 
phor, and  3  mgms,  each  of  acetate  of  morphine  and  of  oleoresin  of 
capsicum.  Dose :  i  pill. 

Ichthyohim  (Ichthyol).  A  black,  tarry  substance,  obtained  from 
bituminous  oil  and  containing  about  15  per  cent  of  sulphur.  Used 
externa'lly  in  skin  diseases. 

Pyr^/^nwi  (Insect  Powder.  Dalmatian  Powder).  The  powdered 
flower  heads  of  a  species  of  chrysanthemum  similar  to  our  daisy. 

lodoformum  (Iodoform).  A  yellow  powder  with  a  peculiar, 
penetrating  odor.  Very  insoluble  in  water.  Used  externally  as  a 
mild  antiseptic. 

/o(/«m  (Iodine).  Bluish-black  crystals.  Very  insoluble  in  water ; 
soluble  in  10  parts  alcohol.     Used  to  make  the  tincture. 

Ipecacuanha  Pidvis  (Powdered  Ipecac).  A  yellowish  powder. 
Used  as  an  emetic.    Dose  as  an  emetic :  i  Gm. 

Ipecacuanha   et   Opii  Ptdvis    (Powder  of    Ipecac   and    Opium. 


MATERIA  MEDICA  AND  THERAPEUTICS         303 

Dover's  Powder).  (Powdered  ipecac  lo,  powdered  opium  lo, 
sugar  of  milk  80.)  A  yellowish-white  powder.  Used  as  a  dia- 
phoretic. Dose :  |  Gm. 

Ipecacuanha;  Fluidextractum  (Fluidextract  of  Ipecac). 
Dose :  0.05  Cc. 

Liquor  Cresolis  Compositus  (Compound  Cresol  Solution).  A 
linseed-oil-soap  solution  of  cresol  of  50  per  cent  strength.  Used  as 
a  disinfectant  in  mixtures  of  i  to  2  per  cent. 

Liquor  Formaldehydi  (Solution  of  Formaldehyde.  Formalin). 
A  solution  containing  37^  per  cent  of  formaldehyde.  A  clear,  color- 
less liquid  having  a  very  pungent  odor.  Used  as  a  disinfectant  by 
vaporization. 

Lithii  Carbonas  (Lithium  Carbonate).  A  white,  odorless  pow- 
der; permanent;  soluble  in  75  parts  of  water.  Used  in  gouty 
troubles.  Dose  :  |  Gm. 

Lithii  Citras  Effervescens  (Lithium  Citrate.  Effervescing).  Tab- 
lets, odorless  and  having  a  cooling,  alkaline  taste,  soluble  in  about 
2  parts  of  water;  insoluble  in  alcohol.  Uses  and  doses  same  as 
carbonate. 

Lycopodium  (Lycopodium).  A  very  light,  pale-yellow  powder, 
Used  as  a  drying  powder  in  pill  boxes. 

Magnesii  Carbonas  (Magnesium  Carbonate).  A  white,  insoluble, 
permanent  powder.     Used  in  acidity  of  the  stomach. 

Dose :  3  Gm. 

Magnesii  Oxidum  (Magnesium  Oxide.  Magnesia.)  A  white, 
bulky  powder,  odorless,  and  having  an  earthy  taste.  Almost  insolu- 
ble in  water.     Used  chiefly  as  an  antidote  to  arsenic. 

Dose:  2  Gm. 

Magnesii  Sulphas  (Magnesium  Sulphate.  Epsom  Salt).  Small, 
colorless  needles,  odorless,  efflosescent ;  soluble  in  0.85  part  of  water. 
Used  as  a  laxative  .  Dose:  15  Gm. 

Menthol  (Menthol).  An  alcohol  obtained  from  oil  of  pepper- 
mint. Colorless  crystals  having  an  odor  of  pepermint.  Only 
slightly  soluble  in  water ;  freely  soluble  in  alcohol.    Used  externally. 

Methylis  Salicylas  (Methyl  Salicylates.  Oil  of  Wintergreen, 
Synthetic).    A  colorless  liquid  having  a  wintergreen  odor. 

Dose :  i  Cc. 

MorphincB  Sulphas  (Sulphate  of  Morphine).  The  salt  of  an  alka- 
loid obtained  from  opium.    White,  feathery  crystals ;  odorless,  per- 


304    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

manent,  and  bitter.  Soluble  in  15.3  parts  of  water.  Sometimes  mis- 
taken for  quinine,  which  it  closely  resembles,  with  fatal  results.  May 
be  distinguished  by  the  action  of  nitric  acid,  which  with  morphine 
gives  an  orange-red  color  fading  to  yellow,  and  with  quinine  does  not 
give  the  color  reaction.  Used  to  relieve  pain. 
Dose:  15  milligrammes. 

Myrrhce  Tinctura  (Tincture  of  Myrrh).  Used  chiefly  in  mouth 
waches.  Doses :  i  Cc. 

Naphthalenum  (Naphthalene).  A  coal-tar  derivative.  Colorless, 
shining,  transparent  laminae. 

Dose :  125  milligrammes. 

Neosalvarsan.  Resembles  salvarsan,  except  that  its  solution  in 
water  is  neutral.     Dose :  300-900  milligrammes. 

Normal  Saline  Solution  Tablets.  Each  contains  2  grams  sodii 
chloridum  and  300  mgms.  sodii  carbonas  monohydratus. 

Nucis  VomiccB  Tinctura  (Tinctura  of  Nux  Vomica).  Used  as  a 
tonic.  Dose :  ^  Cc. 

Nucis  Vomica  Extractum  (Extract  of  Nux  Vomica).  Used  as  a 
tonic.  Dose:  15  milligrammes. 

Oleum  Aurantii  Corticis  (Oil  of  Orange  Peel).  A  pale  yellow 
liquid  used  as  a  flavoring  agent.  Should  be  kept  in  amber-colored 
bottles  in  a  cool  place. 

Oleum  Caryophyli  (Oil  of  Cloves).  A  pale-yellow,  volatile  oil, 
distilled  from  cloves.         Dose :  0.2  Cc. 

Oleum  Gaultherice  (Oil  of  Wintergreen).  A  volatile  oil  distilled 
from  wintergreen  leaves.    Used  in  rheumatism. 

Dose :  i  Cc. 

Oleum  Gossypii  Seminis  (Cottonseed  Oil).  A  fixed  oil  expressed 
from  cottonseed. 

Oleum  Menthce  Piperitce  (Oil  of  Peppermint).  A  volatile  oil  dis- 
tilled from  the  leaves  and  flowers  of  pepermint.  Used  chiefly  for 
flavoring.  Dose :  0.2  Cc. 

Oleum  Morrhuce  (Cod-liver  Oil).  A  fixed  oil  expressed  from 
fresh  livers  of  codfish.     Used  chiefly  in  tuberculosis. 

Dose:  15  Cc. 

Oleum  Ricini  (Castor  Oil).  A  fixed  oil  expressed  from  castor 
beans.     Used  as  a  laxative ;  acts  in  4  to  6  hours. 

Dose:  15  Cc. 


MATERIA  MEDICA  AND  THERAPEUTICS         305 

Oleum  Santali  (Oil  of  Santal).  A  volatile  oil  distilled  from  san- 
dal wood.     Used  in  gonorrhea. 

Dose :  i  Cc. 

Oleum  Theobromatis  (Oil  of  Theobroma.  Cacao  Butter).  A 
fixed  oil  expressed  from  the  roasted  cacao  seeds.  A  yellowish- 
white  solid.     Used  chiefly  as  a  basis  for  sappositories. 

Oleum  Ttglii  (Croton  Oil).  A  fixed  oil  expressed  from  the  seeds 
of  Croton  Tiglium.  A  pale-yellow,  viscid  liquid,  having  an  acrid, 
burning  taste.    Used  as  a  powerful  cathartic;  acts  in  i  to  2  hours. 

Dose :  0.05  Cc. 

Oleum  TerehinthincB  Rectificatum  (Rectified  Oil  of  Turpentine). 
A  thin,  colorless  liquid  used  as  a  stimulant  and  diuretic. 

Dose :  i  Cc. 

Opii  Tinctura  (Tincture  of  Opium.  Laudanum).  Used  to  re- 
lieve pain  and  control  diarrhea.     Dose  :  |  Cc. 

Opii  Tinctura  Camphorata  (Camphorated  Tincture  of  Opium. 
Paregoric).  Contains  opium,  benzoic  acid,  camphor,  and  oil  of 
anise,  each  4,  glycerin  40,  alcohol  950.    Dose :  8  Cc. 

Opii  Pulvis  (Powdered  Opium).    A  brownish  powder. 
Dose :  65  milligrammes. 

Pancreatinum  (Pancreatin).  A  mixture  of  the  digestive  fer- 
ments of  the  pancreas.  A  cream-colored  powder  used  to  aid  diges- 
tion. Dose :  |  Gm. 

Pepsinum  (Pepsin).  A  digestive  fermen  obtained  from  the  hog's 
stomach.     Yellowish  scales  or  a  white  powder. 

Dose:   I  Gm. 

Peptonizing  Tablets.  Contain  pancreatin  and  bicarbonate  of  soda. 
One  tablet  is  sufficient  for  250  Cc.  of  milk. 

Petrolatum  (Vaseline).  A  petroleum  product.  Used  externally 
as  a  basis  for  ointments. 

Petrolatum  Liquidum  (Liquid  Petrolatum.  Liquid  Vaseline). 
A  yellowish,  oily  liquid,  used  externally,  chiefly  in  sprays  for  the 
nose  and  throat. 

Phenol  (Carbolic  Acid).  Obtained  by  distillation  from  coal  tar 
or  prepared  synthetically.  A  white  crytalline  mass  sometimes  ac- 
quiring a  reddish  tint.  Soluble  in  19.6  parts  of  water  and  liquefying 
in  the  presence  of  13.6  per  cent  of  water.  In  poisonous  doses  colors 
the  urine  dark  green.  Used  chiefly  as  an  antiseptic. 
Dose :  65  milligrammes. 
20 


306    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Phenolphthalein  (Tablets).  A  coal  tar  derivative.  White  or 
grayish-white  powder,  soluble  in  600  parts  water.  Used  as  a  mild 
laxative.  Dose :  100-300  milligrammes. 

Phenylis  Saiicylas  (Phenyl  Salicylate.  Salol).  A  white  powder 
having  a  faint  aromatic  odor  and  a  slight  taste.  Soluble  in  2,333 
parts  of  water.     Used  as  an  intestinal  antiseptic. 

Dose :   ^  Gm. 

Physostigmina  Sulphas   (Sulphate   of   Physostigmine).     A  salt 
of  an  alkaloid  obtained  from  physostigma  or  calabar  bean.     A  yel- 
low powder,  deliquescent,  odorless.    Used  in  the  eye. 
Dose :  i  milligramme. 

Pilocarpine  Hydrochloridum  (Pilocarpine  Hydrochloride).  A 
salt  of  an  alkaloid  obtained  from  pilocarpus  or  jaborandi.  Used  as 
a  diaphoretic.  Dose:  10 milligrammes. 

Pilulcu  Catharticce  Composites  (Compound  Cathartic  Pills).  Con- 
tain calomel,  colocynth,  jalap,  and  gamboge.  Each  pill  contains  60 
milligrammes  of  calomel. 

Pilulce  Carminative  (Carminative  Pills).  Each  contains  0.8  mgm. 
morphine  sulphate  with  carminatives. 

Plumbi  Acetas  (Lead  Acetate.  Sugar  of  Lead).  Colorless  crys- 
tals ;  efflorescent,  soluble  in  2  parts  of  water ;  having  a  sweetish  taste. 
Used  as  an  astringent.     Dose :  65  milligrammes. 

Podophylii  Resina  (Resin  of  Podophyllum).  A  grayish- white 
powder  of  peculiar  odor  and  bitter  taste.  Used  as  a  laxative ;  acts 
slowly  in  6  to  12  hours. 

Dose  :  5  to  15  milligrammes. 

Potassii  Acetas  (Potassium  Acetate).  A  white,  very  deliques- 
cent powder,  soluble  in  0.4  part  of  water.     Used  as  a  diuretic. 

Dose :  2  Gm. 

Potassii    Arsenitis    Liquor    (Solution    of    Potassium    Arsenite. 
Fowler's  Solution).    Used  in  malarial  and  skin  diseases. 
Dose :  0.2  Cc.  well  diluted. 

Potassii  Biscarhonas  (Potassium  Bicarbonate).  A  colorless, 
granular,  permanent  powder.     Used  in  rheumatism. 

Dose :  2  Gm. 

Potassii  Bromidum  (Potassium  Bromide).  Colorless  crystals, 
odorless,  permanent;  soluble  in  1.5  parts  of  water;  should  be  admin- 
istered dissolved  in  plenty  of  water. 

Dose :  i  Gm. 


MATERIA  MEDICA  AND  THERAPEUTICS  307 

Potassii  Chloras  (Potassium  Chlorate).  Colorless  plates  or  a 
white  granular  powder;  odorless,  permanent,  soluble  in  i6  parts  of 
water.  Handle  with  care,  as  dangerous  explosions  are  liable  to  fol- 
low trituration  with  organic  substances  like  sugar,  or  oxidizable  sub- 
stances such  as  sulphur.     Dose  :  \  Gm. 

Potassii  et  Sadii  Tartras  (Potassium  and  Sodium  Tartrate.  Ro- 
chelle  Salt).  A  white,  odorless  powder,  soluble  in  about  1.2  parts  of 
water.     Used  as  a  laxative.     Dose :  8  Gm. 

Potassii  Hydroxidum  (Potassium  HydVoxide  Potassa).  Fused, 
white  masses;  odorless,  acrid  tasting,  deliquescent,  caustic.  Not 
used  internally. 

Potassii  lodidum  (Potassium  Iodide).  A  white,  granular  pow- 
der; deliquescent;  soluble  in  0.7  part  of  water;  irritant  to  the  stom- 
ach and  should  be  given  dissolved  in  plenty  of  waater.  Used  espe- 
cially in  syphilis.  Dose  :  |  Gm. 

Potassii    Permanganas     (Potassium     Permanganate).      Slender 
dark-purple  prsims,  permanent,  soluble  in  about  15  parts  of  water. 
Used  chiefly  externally  as  a  skin  disinfectant. 
Dose :  65  milligrammes. 

Protargol.  A  protein  silver  compound  containing  8.3  per  cent  of 
silver,  and  non-irritating  in  character.  A  yellow  powder  soluble  in- 
water.  Used  externally  in  inflammation  of  mucous  membranes,  i 
to  5  per  cent  solutions. 

Pruni  Virginiaiicc  Fluidextractum  (Fluidextract  of  Prunus  Vir- 
ginianae  or  Wild  Cherry).     Used  in  cough  mixtures. 

Dose :  2  Cc. 

Quinince  Hydrochlorosulphas  (Quinine  Hydrochlorosulphate).  A 
salt  of  an  alkaloid  from  cinchona  bark.  Colorless  crystals;  soluble 
in  I  part  of  water.  Used  in  malaria,  especially  for  hypodermic 
purposes.  Dose :  ^  Gm. 

Quinines  Sulphas  (Quinine  Sulphate).    Has  the  same  qualities  as 
the  bisulphate,  but  less  soluble  in  water,  i  :  720.     Used  in  malaria. 
Dose:  i-ioto  i  Gm. 

Rhamni  Purshiancu  Fluidextractum  (Fluidextract  of  Cascara 
Sagrada).    Used  as  a  laxative;  acts  as  such  in  8  to  10  hours. 

Dose :  i  Cc. 

Rhamni Purshiancu  Extractum  (tabellce)  (Cascara  Tablets).    Each 
contains  130  milligrammes  of  extract  of  cascara. 
Dose :  I  to  2  tablets. 


308    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Rhei  Pulvis  (Powdered  Rhubarb  Root).  An  orange-yellow 
powder.    Used  as  a  laxative.     Dose :  i  Gm. 

Saccharum  Lactis  (Sugar  of  Milk).  A  white  powder  from  the 
whey  of  cow's  milk. 

Salophcn  (Salophen).  A  white  powder  containing  about  50.9 
parts  salicylic  acid.  Almost  insoluble  in  water.  Used  in  rheuma- 
tism. Dose :  |  Gm. 

Saharsan.    A  yellow  crystalline  powder  containing  31.5  per  cent 
of  arsenic  metal;  being  readily  oxidizable  it  must  be  kept  in  vacuum 
tubes.     Readily  soluble  in  water  with  acid  reaction. 
Dose :  300-600  milligrammes. 

Santoninum  (Santonin).  Obtained  from  Santonica  flowers. 
Colorless  crystals,  turning  yellow  on  exposure  to  light,  odorless, 
nearly  tasteless,  insoluble,  permanent;  colors  the  urine  a  greenish 
yellow  or  reddish  purple. 

Sapo  Mollis  (Soft  Soap).  A  soft,  unctuous,  yellowish-brown 
mass.    Used  externally. 

Scillce  Syrupus  (Syrup  of  Squill).     Used  in  cough  mixtures. 

Serum  Antidiphthericum  (Diphtheria  Antitoxin).  A  fluid  sepa- 
rated from  the  blood  of  a  horse  immunized  through  the  inoculation 
of  diphtheria  toxin.  Should  be  kept  in  sealed  glass  containers  in  a 
dark,  cool  place.  A  yellowish,  transparent  or  slightly  turbid  liquid. 
It  gradually  loses  its  power. 

Dose,  hypodermically  :  3,000  units.    Immunizing  dose :  500  units. 

Serum  Antitetanicum  (Tetanus  Antitoxin). 

Serum  Antimeningitidis. 

Sinapis  Emplastrum  (Mustard  Plaster). 

Stnapis  Nigra  Pulvis  (Powdered  Black  Mustard). 

Sodii  Bicarhonas  (Sodium  Bicarbonate).  A  white,  odorless  pow- 
der, having  an  alkaline  taste;  soluble  in  12  parts  of  water. 

Dose :  i  Gm. 

Sodv.  Bicarbonaf.  et  MenthcB  Piperitce  Tahellce  (Soda  mint  tab- 
lets). Dose:  1-2  tablets. 

Sodii  Boras  Pulvis  (Powdered  Borax).  A  white,  odorless 
efflorescent  powder,  having  a  sweetish  taste,  soluble  in  20.4  parts 
of  water.     Used  as  an  astringent. 

Dose :    |  Gm. 

Sodii  Bromidum  (Sodium  Bromide)     A  white,  granular  powder, 
odorless;  soluble  in  1.7  parts  of  water.     Used  as  a  sedative. 
Dose :  i  Gm.  well  diluted  with  water. 


MATERIA  MEDICA  AND  THERAPEUTICS  309 

Sodii  Carbonas  Monohydratus  (Dried  Sodium  Carbonate).  A 
white,  odorless  powder  having  a  strongly  alkaline  taste  and  absorbs 
moisture  readily;  soluble  in  2.9  parts  of  water. 

Dose :  ^  Gm. 

Sodii  Fluoridi  (Sodium  Fluoride).  A  powder  used  to  poison 
cockroaches.     Antiseptic.     Poisonous.     External  use  only. 

Sodii  Phosphas  Exsiccatus  (Dried  Phosphate  of  Sodium).  A 
white,  hygroscopic  powder.    Used  as  a  laxative. 

Dose :  i  Gm. 

Sodii  Salicylas  (Sodium  Salicylate).  White  scales,  or  a  color- 
less powder  with  a  faint  pink  tinge ;  odorless  and  having  a  sweetish 
taste ;  soluble  in  about  0.8  part  of  water.  Irritating  to  the  stomach 
and  should  be  dissolved  in  an  abundance  of  water.  Used  in  rheu- 
matism. Dose :  i  Gm. 

Sodii  Thiosulphas  (Sodium  Thiosulphate.  Hyposulphite).  Color- 
less crystals,  odorless  and  having  a  cooling  taste ;  soluble  in  0.35  part 
of  water.     Used  chiefly  externally  in  parasitic  diseases  of  the  skin. 

Spiritus  Frumenti  (Whisky). 

Spiritus  Glycerilis  Nitratis   (Spirit  of  Nitroglycerin).     A  clear 
colorless  liquid  containing  i  per  cent  of  Nitroglycerin. 
Dose:   i  minim  (0.05  Cc). 

Spiritus  Vini  Gallici  (Brandy). 

Strophanthi  Tinctura  (Tincture  of  Strophanthus).  Used  as  a 
heart  tonic  .  Dose :  |  Cc. 

StrychincB  Sulphas  (Strychnine  Sulphate).  The  salt  of  an  alka- 
loid obtained  from  Nux  Vomica.  Colorless,  efflorescent  crystals,  or 
a  white  powder,  odorless,  intensely  bitter.  Soluble  in  31  parts  of 
water.  Dose :  i  milligramme. 

Sulphonethylmethanum  (Trional).  Colorless,  odorless  scales, 
with  a  bitter  taste;  soluble  in  195  parts  of  cold  water,  more  readily 
in  hot  hot  water.     Used  as  a  hypnotic. 

Dose:  i  Gm. 

Sulphonmethanum  (Sulphonal).  Colorless,  inodorous  and  nearly 
tasteless  crystals;  soluble  in  360  parts  of  cold  or  15  parts  of  boiling 
water.     Used  as  a  hypnotic. 

Dose:  i  Gm. 

Sidphur  Lotum  (Washed  Sulphur).  A  fine  yellow  powder, 
odorless,  tasteless,  and  insoluble.    Used  as  a  laxative. 

Dose:  4Gm. 


310    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Synipus  Hypophosphitum  Compositus  (Compound  Syrup  of 
Hyphosphites).  Contains  the  hypophosphites  of  calcium,  potas- 
sium, sodium,  iron,  magnesium;  also  quinine,  strychnine,  citrate 
of  soda,  and  dilute  hypophosphorous  acid.     Used  as  a  tonic. 

Dose :  8  Cc. 

Talcutn  (Ta.\c).    A  white  or  grayish- white  powder.     External  use. 

Terehenum  (Terebene).  Obtained  by  the  action  of  sulphuric 
acid  on  oil  of  turpentine.  A  thin,  colorless  liquid  with  an  agreeable 
odor;  becomes  resinified  on  exposure  to  air  and  light.  Used  as  an 
expectorant.  Dose  r  ^  Cc. 

Thymol    (Thymol).     A  phenol  occurring  in   the   oil   of   thyme. 
Colorless  crystals  having  an  aromatic  odor  and  taste.     Soluble  in 
i,ioo  parts  of  water,  freely  soluble  in  alcohol  and  in  oils. 
Dose :  125  milligrammes. 

Thymolis  lodidum  (Aristol).  A  bright  chocolate-colored  or  red- 
dish-yellow powder,  insoluble  in  water.     Used  externally. 

Tolutanum  Balsamum  (Balsam  of  Tolu).  A  yellowish-brown 
solid,  readily  soluble  in  alcohol,  nearly  insoluble  in  water. 

Dose :  i  Gm. 

Trinitro phenol  (Picric  Acid).  Light  yellow  scales.  Used  chiefly 
externally  for  burns.  The  solution  employed  is  5  parts  picric  acid 
and  75  parts  alcohol  in  1,000  parts  of  water. 

ValeriancB  Fluidextractum  (Fluidextract  of  Valerian).  Used  as 
a  sedative.  Dose :  2  Cc. 

Veronal.  Colorless  crystals,  slightly  bitter  in  taste;  soluble  in  145 
parts  of  water.     Hypnotic.     Dose :  ^  gram  to  i  gram. 

Vinum  Xericum  (Sherry  Wine). 

Zinci  Oxidum  (Zinc  Oxide).  A  fine,  white  powder,  insoluble, 
odorless,  and  tasteless.     Used  externally  in  ointments. 

Dose :  |  Gm. 

Zinci  Phenolsulphonas   (Zinc   Phenolsulphate.      Sulpho-carbolate 
of  Zinc).     Colorless,  odorless,  efflorescent  crystals;  readily  soluble 
in  water  or  alcohol.    Used  chiefly  as  a  local  application. 
Dose :  125  milligrammes. 

Zinci  Sulphas  (Zinc  Sulphate).     Colorless,  efflorescent  crystals; 
odorless  and  having  an  astringent,  metallic  taste ;  soluble  in  0.53  part 
of  water.    Used  externally  and  as  an  emetic. 
Dose  as  an  emetic :  i  Gm. 

Zingiheris  Fluidextractum  (Fluidextract  of  Ginger). 

Dose :  i  Cc. 


CHAPTER   II 

PHARMACY 

Pharmacy  is  the  art  of  preparing  medicines  for  administration. 

Official  Pharmacy  deals  with  the  processes  and  preparation  of  the 
Pharmacopoeia. 

Extemporaneous  Pharmacy  describes  the  methods  of  preparing 
and  dispensing  physicians'  prescriptions. 

A  Pharmacopoeia  is  an  official  list  of  drugs  and  their  preparation 
recognized  by  the  medical  profession  of  a  certain  country ;  such 
drugs  and  methods  are  known  as  official. 

A  Dispensatory  is  a  private  treatise  on  official  and  other  drugs. 

The  National  Formulary  is  a  book  containing  numerous  useful 
formulas  not  found  in  the  Pharmacopoeia,  and  which  have  been 
officially  recognized  by  Congress. 

PHARMACEUTICAL   OPERATIONS 

USE  OF    HEAT 

For  all  operations  requiring  a  temperature  below  that  of  boiling 
water,  an  ordinary  copper  water-bath  is  used;  as  the  vapor  can 
escape  freely,  the  temperature  can  not  rise  above  that  of  boiling 
water. 

MECHANICAL   SUBDIVISION   OF  DRUGS 

It  is  usually  necessary  to  reduce  drugs  to  fine  particles  before 
employing  them  in  the  various  operations  of  pharmacy.  One  of  the 
most  common  of  these  procedures  is  called  trituration,  which  is  the 
process  of  reducing  a  drug  to  a  fine  powder  by  rubbing  it  up  in  a 
mortar ;  the  pestle  is  given  a  rotary  motion  with  downward  pressure, 
describing  a  series  of  concentric  circles  from  within  outward,  and 
then  from  without  inward;  should  the  powder  begin  to  cake,  it  is 
separated  from  the  surface  of  the  mortar  by  a  spatula. 

(311) 


312    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

SOLUTION 

When  a  solid  substance  is  dissolved  in  a  liquid,  both  the  process 
and  the  liquid  are  termed  solution. 

The  liquid  used  to  produce  the  solution  with  a  solid,  is  called  a 
menstruum  or  solvent.  Sometimes  two  solids  may  be  rubbed  together, 
so  as  to  make  a  clear  liquid,  as  for  instance,  camphor  and  chloral 
hydrate. 

Some  hygroscopic  solids  are  apt  to  run  together  and  form  cakes, 
if  powdered  before  solution ;  such  are  the  scale  salts  of  iron,  which 
will  dissolve  more  readily  in  scale  form. 

The  term  "  solubility,"  when  applied  to  a  drug,  and  no  solvent  is 
mentioned,  always  refers  to  water  at  ordinary  temperature. 

Saturated  solutions  are  solutions  which  can  not  take  up  any  more 
of  the  substance  at  ordinary  temperature. 

Percentage  Solutions. —  These  are  solutions  which  contain  a  cer- 
tain definite  percentage  of  a  given  substance.  Percentage  solutions 
of  solids  should  always  be  prepared  by  weight,  while  for  liquid 
substances,  weight  or  volume  may  be  employed. 

The  quantity  of  each  ingredient  necessary  to  make  a  specified 
amount  of  any  particular  percentage  solution,  may  be  found  as  fol- 
lows: Multiply  the  amount  of  solution  desired  in  grammes  by  the 
percentage,  divide  by  lOO,  and  the  result  will  show  the  quantity  of 
solid  drug  necessary;  subtracting  this  amount  from  the  quantity  of 
solution  desired,  the  remainder  indicates  the  necessary  amount  of 
menstruum. 

Some  of  the  most  useful  solvents  of  drugs  are  alcohol,  chloroform, 
ether,  glycerin,  water,  acids,  alkaline  solutions,  and  oils.  The 
resulting  solutions  are  given  various  names,  such  as  tinctures, 
infusions,  etc. 

Water  is  the  most  useful  of  all  solvents;  nearly  all  salts  of  the 
alkalies,  earths,  and  metals  are  dissolved  by  it,  and  many  vegetable 
acids  and  salts  of  the  alkaloids. 

Alcohol  is  next  in  importance  to  water  as  a  solvent.  Its  great 
advantage  over  water  is  that  it  makes  the  preparations  in  which  it 
is  employed  keep  indefinitely,  while  the  watery  solutions  soon  de- 
compose. Resins,  volatile  oils,  alkaloids,  and  glycosides  dissolve  in 
alcohol,  while  gum,  albumen  and  starch  are  insoluble. 

Glycerin  is  used  on  account  of  its  antiseptic  qualities,  when  alcohol 
can  not  be  employed  for  any  reason.     It  dissolves  pepsin,  tannins, 


PHARMACY  313 

some  mineral  salts  and  vegetable  acids,  and  forms  the  basis  of  the 
glycerites. 

Ether  is  especially  valuable  as  a  solvent  for  oils,  fats,  resins,  and 
some  alkaloids  and  neutral  principles. 

Chloroform  resembles  ether  in  its  solvent  properties,  and  also 
dissolves  phosphorus.  It  is  non-inflammable  and  has  a  higher 
boiling-point. 

Acids  are  used  with  water  or  alcohol,  to  extract  the  active  princi- 
ples of  such  drugs  as  cinchona.  They  are  also  used  in  the  prepara- 
tion of  vinegars. 

Alkalies  dissolve  resinous  bodies,  and  the  oils  are  used  as  a  basis 
for  liniments. 

Infusions  are  made  by  pouring  boiling  water  on  vegetable  sub- 
stances, and  letting  them  stand  for  various  lengths  of  time. 
Decoctions  are  made  by  boiling  the  drug  in  water,  and  are  used 
when  there  are  no  volatile  principles  to  be  driven  off.  Maceration 
is  a  process  of  dissolving  out  active  principles  at  ordinary  tempera- 
tures.    The  mixture  must  be  frequently  shaken. 

Percolation  or  displacement  is  one  of  the  most  important  and 
generally  useful  processes  of  pharmacy.  By  means  of  it,  a  powder 
contained  in  a  suitable  vessel  has  its  solid  constituents  dissolved  out, 
by  the  descent  of  solvent  through  it.  The  apparatus  in  which  the 
process  is  carried  on  is  known  as  a  percolator,  the  resulting  solution 
as  the  percolate,  and  the  residue  as  the  marc.  The  directions  of  the 
United  States  Pharmacopoeia  are  as  follows: 

"Percolation,  as  directed  in  this  Pharmacopceia,  consists  in  sub- 
jecting a  substance  or  a  mixture  of  substances,  in  powder,  contained 
in  a  vessel  called  a  percolator,  to  the  solvent  action  of  successive 
portions  of  a  certain  menstruum  in  such  a  manner  that  the  liquid, 
as  it  traverses  the  powder  in  its  descent  to  the  receiver,  shall  be 
charged  with  the  soluble  portion  of  it,  and  pass  from  the  percolator 
free  from  insoluble  matter, 

"  When  the  process  is  successfully  conducted,  the  first  portion  of 
the  liquid,  or  percolate,  passing  through  the  percolator,  will  be  nearly 
saturated  with  the  soluble  constituents  of  the  substance  treated ;  and 
if  the  quantity  of  menstruum  be  sufficient  for  its  exhaustion,  the 
last  portion  of  the  percolate  will  be  nearly  free  from  color,  odor, 
and  taste,  other  than  those  of  the  menstruum  itself. 

"Percolators. —  The  percolator  most  suitable  for  the  quantities 


314    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

contemplated  by  this  PharmacopCEia  should  be  nearly  cylindrical,  or 
slightly  conical,  with  a  funnel  shaped  termination  at  the  smaller  end. 
(See  Fig.  218.)  The  neck  of  this  funnel  end 
should  be  rather  short,  and  should  gradually  and 
regularly  become  narrower  toward  the  orifice,  so 
that  a  perforated  cork,  bearing  a  short  glass  tube, 
may  be  tightly  wedged  into  it  from  within  until 
the  end  of  the  cork  is  flush  with  the  outer  edge 
of  the  orifice.  The  glass  tube,  which  must  not 
project  above  the  inner  surface  of  the  cork, 
should  extend  from  3  to  4  Cm.  beyond  the  outer 
surface  of  the  cork,  and  should  be  provided  with 
a  closely  fitting  rubber  tube,  at  least  one-fourth 
Fig.  218.— Percolator,  longer  than  the  percolator  itself,  and  ending  in 
another  short  glass  tube,  whereby  the  rubber  tube  may  be  so  sus- 
pended that  its  orifice  shall  be  above  the  surface  of  the  menstruum  in 
the  percolator,  a  rubber  band  holding  the  tube  in  position. 

"  The  shape  of  a  percolator  should  be  adapted  to  the  nature  of 
the  drug  to  be  operated  upon.  For  drugs  which  are  apt  to  swell, 
particularly  when  a  feeble  alcoholic  or  an  aqueous  menstruum  is 
employed,  a  conical  percolator  is  preferable.  A  cylindrical  or  only 
slightly  tapering  percolator  may  be  used  for  drugs  which  are  not 
liable  to  swell,  and  when  the  menstruum  is  strongly  alcoholic,  or 
when  ether  or  some  other  volatile  liquid  is  used  for  extraction. 
The  size  of  the  percolator  selected  should  be  in  proportion  to  the 
quantity  of  drug  extracted.  When  properly  packed  in  the  perco- 
lator, the  drug  should  not  occupy  more  than  two-thirds  of  its  height. 
The  percolator  is  best  constructed  of  glass,  but,  unless  otherwise 
directed,  may  be  made  of  any  suitable  material  not  aflfected  by  the 
drug  or  menstruum. 

"  The  percolator  is  prepared  for  percolation  by  gently  pressing  a 
small  tuft  of  cotton  into  the  neck  above  the  cork,  and  this  may  then 
be  moistened  by  pouring  a  few  drops  of  the  menstruum  upon  the 
cotton,  to  facilitate  the  passage  of  the  first  portion  of  percolate, 
which  is  often  very  dense. 

"  The  Process. —  The  powdered  substance  to  be  percolated  (which 
must  be  uniformly  of  the  fineness  directed  in  the  formula,  and 
should  be  perfectly  air  dry  before  it  is  weighed)  is  put  into  a  basin. 


PHARMACY  315 

the  specified  quantity  of  menstruum  is  poured  on,  and  the  powder 
thoroughly  stirred  with  a  spatula,  or  other  suitable  instrument, 
until  it  appears  uniformly  moistened.  The  moist  powder  is  then 
passed  through  a  coarse  sieve  —  No.  40  powders,  and  those  which 
are  finer,  requiring  a  No.  20  sieve,  while  No.  30  powders  require  a 
No.  15  sieve  for  this  purpose.  Powders  of  a  less  degree  of  fine- 
ness usually  do  not  require  this  additional  treatment  after  the  mois- 
tening. The  moist  powder  is  now  transferred  to  a  sheet  of  thick 
paper  and  the  whole  quantity  poured  from  this  into  the  percolator. 
It  is  then  shaken  down  lightly  and  allowed  to  remain  in  that  con- 
dition for  a  period  varying  from  fifteen  minutes  to  several  hours, 
unless  otherwise  directed ;  after  which  the  powder  is  pressed,  by 
the  aid  of  a  plunger  of  suitable  dimensions,  more  or  less  firmly,  in 
proportion  to  the  character  of  the  powdered  substance  and  the  alco- 
holic strength  of  the  menstruum,  strongly  alcoholic  menstrua,  as  a 
rule,  permitting  firmer  packing  of  the  powder  than  the  weaker. 
The  percolator  is  now  placed  in  position  for  percolation,  and,  the 
rubber  tube  having  been  fastened  at  a  suitable  height,  the  surface 
of  the  powder  is  covered  by  an  accurately  fitting  disk  of  filtering 
paper,  or  other  suitable  material,  and  a  sufficient  quantity  of  the 
menstruum  poured  on  through  a  funnel  reaching  nearly  to  the  sur- 
face of  the  paper.  If  these  conditions  be  accurately  observed,  the 
menstruum  will  penetrate  the  powder  equally  until  it  has  passed 
into  the  rubber  tube  and  has  reached,  in  this,  a  height  correspond- 
ing to  its  level  in  the  percolator,  which  is  now  closely  covered  to 
prevent  evaporation.  The  apparatus  is  then  allowed  to  stand  at 
rest  for  the  time  specified  in  the  formula. 

"  To  begin  percolation,  the  rubber  tube  is  lowered  and  its  glass 
end  introduced  into  the  neck  of  a  bottle  previously  marked  for  the 
quantity  of  liquid  to  be  percolated,  if  the  percolate  is  to  be  measured, 
or  of  a  tarred  bottle,  if  the  percolate  is  to  be  weighed ;  and  by  raising 
or  lowering  this  receiver  the  rapidity  of  percolation  may  be  in- 
creased or  decreased  as  may  be  desirable.  A  layer  of  men- 
struum must  constantly  be  maintained  above  the  powder,  so 
as  to  prevent  the  access  of  air  to  its  interstices,  until  all^  has 
been  added,  or  the  requisite  quantity  of  percolate  has  been  obtained. 
This  is  conveniently  accomplished,  if  the  space  above  the  powder 
will  admit  it,  by  inverting  a  bottle  containing  the  entire  quantity  of 
menstruum  over  the  percolator  in  such  a  manner  that  its  mouth  may 


316    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

dip  beneath  the  surface  of  the  liquid,  the  bottle  being  of  such  shape 
that  its  shoulder  will  serve  as  a  cover  for  the  percolator. 

"  When  the  dregs  of  a  tincture,  or  of  a  similar  preparation,  are 
to  be  subjected  to  percolation,  after  maceration  with  all  or  with  the 
greater  portion  of  the  menstruum,  the  liquid  portion  should  be 
drained  off  as  completely  as  possible,  the  solid  portion  packed  in  a 
percolator,  as  before  described,  and  the  liquid  poured  on,  until  all 
has  passed  from  the  surface,  when  immediately  a  sufficient  quantity 
of  the  original  menstruum  should  be  poured  on  to  displace  the 
absorbed  liquid,  until  the  prescribed  quantity  has  been  obtained." 

SEPARATION    OF   SOLIDS   FROM   LIQUIDS 

Filtration  is  the  process  of  separating  solids  from  liquids  so  as  to 
render  the  latter  more  transparent.  Colation  or  straining  is  differ- 
ent from  filtration  only  in  that  it  is  less  thorough.  For  straining, 
filter-bags,  conical  in  form,  and  made  of  felt  or  flannel,  are  usually 
employed. 

For  filtration,  two  kinds  of  paper  filters  are  used,  plain  and  plaited. 
Plain  filters  are  usually  employed  when  it  is  desired  to  collect  the 
solid  matter,  called  the  precipitate.  It  is  made  by  doubling  a  circu- 
lar sheet  of  filter  paper  upon  itself,  then  refolding  this  in  the  middle ; 
the  filter  is  then  opened  in  such  a  manner  that  there  is  one  thickness 
on  one  side  and  three  thicknesses  of  paper  on  the  other  side  of  the 
cone,  which  exactly  fits  an  ordinary  funnel. 

A  plaited  filter  exposes  a  much  larger  filter  surface,  that  does  not 
come  in  contact  with  the  funnel,  thus  effecting  a  much  more  rapid 
filtration.  The  method  of  preparing  a  plaited  filter  is  shown  in  all 
works  on  pharmacy.  In  plaiting  a  filter,  do  not  extend  the  creases 
entirely  to  the  apex,  for  the  point  of  the  filter  may  be  so  much 
weakened  that  the  weight  of  the  liquid  would  tear  it.  The  upper 
edge  of  the  filter  should  not  reach  the  top  of  the  funnel;  this  Is  in 
order  to  allow  the  funnel  to  be  covered  to  keep  out  dust.  The 
filter  should  be  moistened  with  water  after  placing  in  the  funnel, 
and  before  adding  the  liquid  to  be  filtered;  the  latter  should  be 
poured  quietly  on  the  side  of  the  filter,  so  as  not  to  rupture  the 
point.  In  filtering  into  a  bottle,  place  a  piece  of  twine  between  the 
funnel  and  bottle^  to  allow  the  escape-of  air. 

The  process  of  separating  a  liquid  from  the  solid,  by  pouring  ofif 
the  liquid,  after  the  solid  settles,  is  called  decantation;  it  may  be 
greatly  assisted  and  the  spilling  of  the  liquid  avoided,  by  using  a 
glass  rod  as  a  director. 


PHARMACY 


317 


When  the  sohd  substance  or  precipitate  is  light  and  easily  mixed 
with  the  liquid,  it  is  better  to  use  a  siphon.  This  usually  consists  of 
an  ordinary  glass  tube,  bent  at  a  rather  acute  angle,  and  with  the 
two  arms  of  different  length.  The  siphon  is  first  entirely  filled  with 
the  liquid  to  be  drawn  off,  and  the  shorter  arm  is  then  inserted  in 
the  liquid,  taking  care  to  keep  the  end  of  the  longer  arm  below  the 
surface  level.  The  empty  siphon  may  be  inserted  into  the  liquid 
and  the  flow  started  by  suction  on  the  long  arm,  provided  the  liquid 
is  not  corrosive  or  poisonous.  A  rubber  tube  may  be  used  as  a 
siphon,  in  place  of  a  glass  tube,  and  in  the  same  way. 

SEPARATION    OF   VOLATILE   MATTER 

Volatile  substances  are  separated  from  those  which  are  less  vola- 
tile, by  the  action  of  heat,  and  the  process  is  known  as  vaporization. 

The  process  of  separating  a  volatile  liquid  from  a  less  volatile 
one,  by  heat,  is  called  evaporation. 

When  the  purpose  sought  is  to  obtain  the  volitile  liquid,  it  is  called 
distillation. 

When  the  purpose  is  to  obtain  the  solid,  it  is  called  desiccation. 

When  it  is  wished  to  separate  a  volitile  solid  from  another  solid 
body,  it  is  called  sublimation. 

OFFICIAL  PREPARATIONS  ^ 


Liquids. 

Solids. 

Made    without    perco- 
lation     or     macera- 

Made   by    percolation 

Made    by    percolation 

Made    without 
lation      or 

perco- 
macera- 

tion. 

or  maceration. 

or  maceration. 

tion.2 

Aqueous  Solutions. 

Aqueous  Liquids. 

Extracts. 

Powders. 

Waters. 

Infusions. 

Resins. 

Triturations. 

Solutions. 

Decoctions. 

Masses. 

Aqueous          Solutions 

Alcoholic  Liquids. 

Confections. 

Containing            Sweet 

Tinctures. 
Wines. 

Pills. 
Troches. 

or        Viscid         Sub- 

Fhiidextracts. 

Cerates. 

stances. 

Oleoresinous  Liquids. 

Ointments. 

Syrups. 
Honeys. 

Mucilages. 

Oleoresins. 

Plasters. 

Acetous  Liquids. 

Vinegars. 

Papers. 
Suppositories. 

Emulsions. 

Mixtures. 

Glvcorites. 

Alcoholic   Solutions. 

Spirits. 

Elixirs. 

Ethereal  Solutions. 

Collodions. 

Oleaginous    Solutions. 

Liniments. 

Oleates. 

1  Those  used  internally  are  in  Roman  type;    those  used  externally,  in  italics. 

2  The  preparations  in  this  class  are  mostly  extemporaneous. 


318    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Aqticp,  zvaters,  are  solutions  of  volatile  substances  in  water.  They 
do  not  keep  well  and  should  be  freshly  prepared. 

Cerata,  cerates,  are  ointments  made  stiff  with  wax. 

Charter,  papers,  are  medicated  papers  such  as  mustard  paper. 

Collodia,  collodions,  have  as  their  basis  a  solution  of  gun-cotton  in 
alcohol  and  ether. 

Decocta,  decoctions,  are  made  by  boiling  vegetable  substances  in 
water;  little  used. 

Elixiria,  elixirs,  are  sweetened,  aromatic,  alcoholic  preparations 
serving  as  a  pleasant  vehicle  for  medicines. 

Emplastra,  plasters,  are  solid  compounds,  usually  spread  on 
muslin,  and  for  external  use.     Example :   Belladonna  plaster. 

Emidsa,  emidsions,  are  suspensions  of  insoluble  oily  or  resinous 
substances  in  water  by  means  of  some  other  substance,  such  as  gum 
arabic  or  the  yolk  of  tgg  known  as  the  excipient. 

Extracta,  extracts,  are  semisolid  preparations  obtained  by  evapo- 
rating watery  or  alcoholic  solutions  of  the  active  principles  of  drugs. 

Fluidextracta,  fliiidextracts,  are  permanent,  concentrated  solutions 
(usually  alcoholic)  of  vegetable  drugs  of  such  strength  that  i  Cc.  of 
the  fluidextract  represents  i  Gm.  of  the  drug. 

Glycerita,  glycerites,  are  mixtures  of  medicinal  substances  with 
glycerin. 

Infiisa,  infusions,  are  prepared  by  treating  vegetable  substances 
with  hot  or  cold,  but  not  boiling  water. 

Linimenta,  liniments,  are  solutions  or  mixtures  of  various  sub- 
stances in  alcoholic  or  oily  liquids,  and  intended  for  external  use, 
with  rubbing. 

Liquores,  solutions,  are  solutions  of  non-volatile  substances  in 
water. 

Mistura,  mixtures,  are  suspensions  of  insoluble  substances  in 
water  by  the  aid  of  some  viscid  body. 

Oleoresince,  oleoresins,  are  liquid  preparations  consisting  princi- 
pally of  natural  oils  and  resins  extracted  by  ether. 

Pihda,  pills,  are  spherical  masses  to  be  swallowed  whole.  They 
consist  of  the  active  ingredients  and  the  excipient,  the  latter  being 
the  substance  used  to  make  the  mass  adhesive  and  plastic.  Glycerin 
and  acacia  are  excipients. 

Spiritus,  spirits,  are  alcoholic  solutions  of  volatile  substances. 

Suppositoria,   suppositories,   are    solid    bodies    containing    drugs 


PHARMACY  319 

usually  incorporated  with  cacao  butter  and  intended  for  use  in  the 
vagina,  rectum,  or  urethra. 

Syrupi,  syrups,  are  concentrated  solutions  oi  sugar  in  water  with 
or  without  medicinal  substances. 

Tabetics,  tablets,  consist  of  powdered  drugs  compressed  into  disc 
shape  by  machinery.  They  are  extensively  used  in  the  field  supply 
table  because  they  are  convenient  for  transportation  and  for  accurate 
dosage  without  weights  or  measures.  Their  disadvantages  are  that 
they  are  so  firmly  compressed  that  if  swallowed  whole  many  of  them 
pass  through  the  gastro-intestinal  tract  unchanged,  and  that  there- 
fore they  must  be  first  reduced  to  a  powder  before  being  taken. 
Others  are  very  irritating  to  the  stomach  and  should  be  dissolved 
freely  in  water  before  being  administered. 

Tincturce,  tinctures,  are  solutions  of  non-volatile  substances  in 
alcohol.  Tincture  of  iodine  is  an  exception,  iodine  being  a  volatile 
substance.  Potent  tinctures  are  of  lo  per  cent  strength  and  other 
tinctures  usually  20  per  cent. 

Trochisci,  troches  or  lozenges,  are  small  cakes  of  medicines  incor- 
porated with  a  mass  which  usually  has  sugar  for  a  basis.  They  are 
used  by  allowing  them  to  dissolve  slowly  in  the  mouth. 

Unguenta,  ointments,  are  soft,  fatty  mixtures  of  medicinal  agents 
usually  with  a  basis  of  lard  and  wax  or  petrolatum. 

NON-OFFICIAL   FORMS   OF   MEDICINES 

Bou'gia,  bougie,  a  urethral  suppository. 

Ca'psula,  capsule,  a  small,  hollow,  gelatin  receptacle  for  medicines, 
intended  to  be  swallowed,  and  thus  concealing  the  taste  of  its 
contents. 

Catapla'sma,  poultice. 

Cha'rtula,  small  paper,  the  subdivision  of  powders  into  separate 
doses  inclosed  by  small  pieces  of  paper,  folded. 

Colly'rium,  eye-water. 

Di'scus,  disk,  a  small,  flat  piece  of  medicated  gelatin,  used  when 
the  dose  is  small,  especially  with  alkaloids,  for  application  to  the  eye, 
or  for  use  in  hypodermatic  syringe. 

E'nema,  enema,  a  rectal  injection. 

Esse'ntia,  spirits,  essence,  solution  of  volatile  oil  in  alcohol. 

Gargari'sma,  gargle. 


320    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 


Gra'nulum,  a  small  pill,  a  granule. 

Hau'sttis,  draught,  when  a  considerable  amount  of  fluid  is  to  be 
swallowed  at  one  dose. 

Itihala'tio,  inhalation,  a  vapor. 
Inje'ctio,  injection. 
Lo'tio,  lotion,  a  wash. 
Po'tus,  drink,  a  draught. 
Su'ccus,  juice. 

Tablet  triturates.  Triturations  compressed  into  small  masses,  for 
exact  dosage  and  convenience  of  administration. 

Tablets,  hypodermic.  Small  masses  containing  exact  doses  of  sub- 
stances used  for  hypodermatic  administration;  some  innocent  but 
soluble  substance  is  used  as  the  basis. 

Among  the  preparations  which  are  most  often  made  in  the  dis- 
pensary are  emulsions,  pills,  ointments,  powders,  and  suppositories; 
it  is,  therefore,  necessary  to  consider  these  operations  a  little  more 
in  detail. 

Emulsions.  Milk  and  yolk  of  egg  are  natural  emulsions,  the  fat 
in  each  case  being  divided  into  minute  globules  which  are  surrounded 
with  a  film  of  albumen  or  casein  by  which  they  are  suspended  in 
water;  the  artificial  emulsions  are  imitations  of  those  existing  in 
nature. 

The  most  commonly  used  excipients  are  acacia  and  yolk  of  eggs 

(vitellus),  but  emulsions  made  with 
the  latter  must  be  used  within  a 
few  days,  as  they  do  not  keep  well. 
The  method  of  preparing  an 
emulsion  which  experience  has 
shown  to  be  the  best  is  as  follows : 
Add  the  oil,  resin,  etc.,  to  a  proper 
quantity  of  the  excipient  and  mix 
both  thoroughly  in  a  mortar  (Fig. 
219).     Then  add  enough  water  to 

Fig.   219.— Wedgewood  Mortar  and  Pestle,    equal    OUC-half     the    Weight    of     the 

previous  mixture,  and  triturate  the  whole  rapidly  and  unceasingly 
until  the  emulsion  is  homogeneous  and  of  a  whitish  color.  Next 
add  the  remainder  of  the  water  slowly,  with  continual  stirring, 
finally  incorporating  the  other  ingredients,  if  any. 


PHARMACY 


321 


Pills.  Pills  should  not  exceed  five  grains  in  weight  unless  com- 
posed of  a  heavy  substance  such  as  calomel.  The  ingredients  should 
be  weighed  out  separately,  commencing  with  that  of  which  the 
smallest  quantity  is  ordered,  and  thoroughly  rubbed  up  in  a  mortar ; 
the  excipient  is  then  added  and  the  rubbing  continued  until  the  mass 

is  of  the  proper  consist- 
ence and  does  not  show 
any  particles  of  any  one 
ingredient.     If  the  mass 

Fig.  220.— Spatula.  Sticks    tO   the    pCStlc    it   is 

removed  with  a  spatula 
(Fig.  220)  and  may  be  kneaded  a  few  minutes  in  the  fingers.  It 
should  then  be  placed  upon  the  pill  tile,  which  has  been  previously 
dusted  with  a  little  lycopodium,  and  rolled  into  a  long  cylinder  by  the 
aid  of  a  broad  spatula  until  the  mass  is  of  a  length  corresponding  to 
the  division  on  the  tile  scale  which  represents  the  number  of  pills  to 
be  made. 

The  mass  should  then  be  placed  along  the  scale  and  a  cut  made 
through  it  with  the  spatula  at  each  division,  the  pieces  being  at  once 
rounded  separately  into  pills  by  the  thumb  and  the  two  fingers  of 
each  hand.  A  pill  machine  may  be  used  for  the  division  of  the 
portions  (Fig.  221). 

The  pills  are  then  left  to  dry  while  the  label  is  being  written,  after 
which  they  are  placed  in  a  pill  box  with  a  little  lycopodium  to  pre- 
vent their  sticking  together. 

The  excipient  to  be  used  is  usually  left  to  the  discretion  of  the 


Fig.  221. —  Pill  Machine. 


compounder.      Some   substances   such   as   the  softer  extracts   and 
gum  resins  need  no  excipient,  but  may  be  made  at  once  into  pills. 
Among  the  more  generally  used  excipients  are: 
21 


322    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Glycerin:  Valuable  on  account  of  its  property  of  attracting  mois- 
ture and  thus  preventing  the  pills  getting  too  hard. 

Syrup:  Should  not  be  used  for  metallic  salts,  especially  calomel, 
which  it  reduces  in  a  short  time. 

Mucilage  of  Acacia:   For  vegetable  powders  not  adhesive. 

Water:  For  vegetable  powders  containing  mucilage. 

Alcohol:   For  resinous  substances. 

Soap:  Best  for  resinous  and  fatty  substances  and  essential  oils. 

Ointments:  Ointments  are  usually  prepared  by  rubbing  the  ingre- 
dients together  in  a  mortar,  or  thoroughly  incorporating  them  on  a 
pill-tile  with  the  aid  of  a  firm  spatula.  When  resins  or  waxes  are  to 
be  incorporated  with  fats,  or  medicines  are  used  which  are  soluble 
in  warm  fats,  melting  is  used.  When  extracts,  powders,  or  gritty 
substances  are  ordered,  the  ingredients  should  first  be  finely 
powdered,  then  rubbed  with  a  small  quantity  of  the  basis  into  a 
smooth,  impalpable  paste,  the  remainder  of  the  basis  being  added 
gradually  until  the  whole  is  thoroughly  incorporated. 

Soluble  salts  should  be  triturated  with  a  little  water  before  adding 
the  basis.  Camphor  needs  a  litle  alcohol  to  enable  it  to  be  pul- 
verized. Volatile  substances  should  be  added  last  to  allow  of  as 
little  evaporation  as  possible. 

Pozvders:  Substances  which  are  insoluble  and  too  bulky  to  be  pre- 
scribed in  pills  are  often  ordered  in  the  form  of  powder.  The  in- 
gredients are  to  be  thoroughly  mixed  and  accurately,  divided.  The 
mixing  is  usually  done  in  a  mortar  unless  it  is  explosive,  but  may  be 
effected  on  a  pill-tile  with  the  aid  of  a  spatula.  Substances  such  as 
alkaloids  are  very  active  and  when  employed  in  small  doses  require 
some  inert  substance  to  give  them  bulk  sufficient  for  division  and 
handling;  sugar  of  milk  is  usually  employed  for  the  purpose.  The 
active  ingredient  is  placed  in  the  mortar  first  and  thoroughly  mixed 
with  a  small  quantity  of  the  diluent,  the  addition  being  gradually 
continued. 

Powders  are  dispensed  in  bulk  when  the  dose  is  large,  or  in  papers, 
chartulas,  when  the  dose  is  small. 

•Hygroscopic  and  effervescent  powders  should  be  dispensed  in 
waxed  paper,  others  in  ordinary  white  paper.  The  paper  should  be 
cut  to  fit  the  powder  and  folded  to  fit  the  box.  It  should  be  the  rule 
to  weigh  out  separately  each  dose  of  the  active  ingredients. 

Suppositories:    Rectal    and    vaginal    suppositories    usually    have 


PHARMACY  323 

cacao  butter  as  a  basis,  while  glycerinated  gelatin  is  commonly  em- 
ployed for  the  urethra.  Rectal  suppositories  are  cone-shaped  and 
weigh  from  one  to  two  grammes.  Urethral  suppositories  are  pencil- 
shaped,  and  either  seven  centimeters  in  length,  weighing  two 
grammes,  or  fourteen  centimeters  in  length,  weighing  four  grammes. 
Vaginal  suppositories  should  be  globular  or  egg-shaped  and  weigh 
about  four  grammes. 

Cacao  butter  suppositories  are  prepared  by  reducing  the  medicine  ' 
to  a  powder  or  softening  it,  and  then  rubbing  it  up  in  a  mortar  with 
an  equal  quantity  of  the  finely  grated  excipient  until  a  smooth  paste 
is  formed,  after  which  the  remainder  of  the  excipient  is  slowly 
added.  A  little  castor-oil  or  glycerin  may  be  added  to  make  the 
mass  more  plastic.  Next  roll  the  mass  on  a  graduated  tile  until  a 
cylinder  of  the  proper  length  is  formed,  divide  this  into  the  required 
number  of  equal  parts,  and  with  a  spatula  form  them  into  the 
desired  shape.  Cacao  butter  suppositories  may  also  be  prepared  by 
melting  the  ingredients  together  and  molding  them. 

Gelatin  urethral  suppositories  are  prepared  by  dissolving  or  thor- 
oughly mixing  the  medicine  with  a  little  water  and  sufficient  glycerin 
to  make  the  weight  of  the  mixture  one-half  that  of  the  finished 
product.  Then  carefully  incorporate  it  with  an  equal  weight  of 
melted  glycerinated  gelatin,  and  pour  it  at  once  into  suitable  molds 
which  have  been  greased  with  a  small  quantity  of  petrolatum.  Cool 
the  molds  before  removing  the  suppositories. 

WEIGHTS   AND   MEASURES 

Three  different  systems  of  weights  and  measures  are  used  in  this 
country,  avoirdupois  weight,  apothecaries'  weight,  and  metric  weight. 

Avoirdupois  weight  is  used  in  the  purchase  and  sale  of  drugs. 
The  divisions  of  avoirdupois  weight  are  the  pound,  ounce,  drachm, 
and  grain,  which  are  represented  by  the  following  characters:  lb., 
oz.,  drm.,  gr. ;  each  pound  contains  i6  ounces  and  each  ounce  i6 
drachms  or  437>^  grains.  The  term  drachm  is  rarely  employed, 
quantities  less  than  an  ounce  being  usually  designated  b/  common 
fractions,  such  as  1/16  oz.,  3^  oz.,  j4  oz.,  or  in  grains. 

Apothecaries'  weight  is  frequently  employed  in  the  writing  and 
compounding  of  physicians'  prescriptions,  and  is  divided  into  grains, 
scruples,  drachms,  and  ounces,  of  which  20  grains  are  equal  to  i 
scruple,  3  scruples  are  equal  to  i  drachm,  and  8  drachms  are  equal  to 
I  ounce,. 


324    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 


TABLE  OF   APOTHECARIES    WEIGHT 


Grain. 

(Gra'num.) 
Symbol:    gr. 

Scruple. 
(Scru'pulus.) 
Rarely  em- 
ployed now. 

Drachm. 
(Dra'chma.) 

Ounce. 
(U'ncia.) 

Pound. 

(Li'bra.) 

lb. 

20. 

60. 

480. 
5. 760. 

I. 
3. 

24. 
288. 

3. 

8. 
96. 

I. 
12. 

I. 

TABLE   OF 

apothecaries' 

measure 

Minim. 

(Mi'nimum.) 

Symbol: 

Fluidrachm. 
(Fluidra'chma.) 

Fluidounce. 
(Fluidu'ncia.) 

Pint. 

(Octa'rius.) 

0. 

Gallon, 
(Co'ngius.) 

c. 

60. 

480 

7,680. 

61,440. 

I . 

8. 

128. 

1,024. 

.  128. 

I. 
8. 

I. 

The  metric  or  decimal  system  is  prescribed  for  use  in  the  medical 
department  of  the  army.  The  name  metric  is  derived  from  one  of 
the  units  of  the  system,  the  meter  or  unit  of  length,  which  is  the 
forty-millionth  part  of  the  earth's  circumference  around  the  poles. 

The  unit  of  capacity  is  the  liter,  which  is  equal  to  1,000  cubic  centi- 
meters. The  unit  of  weight  is  the  gramme,  which  is  the  weight  of 
one  cubic  centimeter  of  water  at  its  maximum  density.  The  prefixes 
which  indicate  multiplication  are  Deka  (10),  Hecto  (100),  and  Kilo 
(1,000),  while  division  is  indicated  by  Deci  (i-io),  Centi  (i-ioo), 
and  Milli  (i-iooo). 

The  system  resembles  the  United  States  money  system,  which  is 
also  decimal,  in  the  latter  the  dollar  is  the  unit,  and  there  are  mills 
(i-iooo),  cents  (i-ioo),  dimes  (i-io),  and  eagles  (10);  like  the 
money  system,  too,  only  a  few  of  the  terms  are  used  in  pharmacy; 
thus  we  use  cubic  centimeters  (Cc),  kilogrammes  (Kilo),  gramme 
(Gm.),  and  milligramme  (Mgm.)  ;  also  the  term  ^A  gramme  and  % 
gramme  may  be  employed.  Fractional  parts  of  a  dollar  may  be 
written  in  several  ways,  thus :  $0.50,  50  cents,  and  500  mills,  all 
mean  the  same  thing,  and  so  do  grammes  0.50,  50  centigrammes,  and 
500  milligrammes ;  but  while  we  use  cents  as  applied  to  fractional 
parts  of  a  dollar,  we  usually  employ  mills  as  applied  to  fractional 
parts  of  a  gramme. 

Concerning  the  relative  values  of  these  two  systems  of  weights  and 
measures,  there  can  be  no  question  of  the  great  advantage  of  the 
Metric  over  the  Apothecaries'  system.  The  former  is  founded  upon 
a  decimal  basis,  and  thus  everything  is  in  tens;  thus  it  is  easier  to 
compute  amounts  and  divide  doses ;  it  is  expressed  more  easily ;  then, 


PHARMACY 


325 


again,  there  is  an  exact  correspondence  between  the  metric  system  of 
weights  and  the  measures  —  one  cubic  centimeter  of  water  at  4°  C. 
weighing  exactly  one  gramme.  In  the  Apothecaries'  system,  such 
an  exact  correlation  does  not  exist,  the  minim  not  weighing  exactly 
one  grain,  and  one  fluidounce  of  water  (480  minims)  weighing  only 
455  grains ;  the  difference  is,  however,  only  trifling,  and  in  the  case 
of  liquids  having  a  specific  gravity  differing  but  little  from  that  of 
water,  need  not  be  considered ;  and  thus  we  can,  as  a  rule,  take  one 
minim  as  one  grain. 

The  quantities  are  expressed  much  more  simply  m  the  Metric 
than  in  the  Apothecaries'  system ;  instead  of  being  required  to  place 
the  sign  before  each  figure,  we  place  on  the  top  of  the  column  the 
words  "  grammes,'  or  "  cubic  centimeters  "  and  then  below  this  the 
figures,  separating  the  whole  numbers  from  decimals  either  by  a 
line  or  period;  or  "grammes"  or  "cubic  centimeters"  may  be 
abbreviated  to  "  Gm."  or  "  Cc." 

Translation  from  one  system  into  the  other  can  be  done  very 
easily,  as  will  be  seen  from  the  following  tables.  The  approximate 
equivalents  are  the  ones  ordinarily  to  be  employed,  the  exact  ones 
being  added  for  reference  only : 


TABLE  OF   EQUIVALENTS 

Length 
Meters.  Inches. 

I         39-37 

0.1     3-93 

o.oi   39 

Capacity 
Liters  Fluidounces  Minims 

I         33.81 

0.01   (Cc.)    15 

Weight 
Grammes  Grains 

I  15-43  ( 1 5i  approximately). 

0.1      1.54  (   I  ^approximately). 

0.01    15  (     I  approximately). 

o.ooi 015  (        approximately). 


326    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

TAHLK  OF  EQUIVALENTS  —  Continued. 

Domestic  Measures 

I  teaspoon  ful  =  approximately     5  Cc. 

I  dessertspoonful  =  approximately  10  Cc. 

I  tablespoonful       ==  approximately  15  Cc. 

To  convert  metric  weights  and  measures  into  those  in  ordinary 
use,  and  vice  versa,  multiply  by  the  corresponding  equivalents. 

To  convert : 

Meters  into  inches,  multiply  by  39.370. 
Example:  39 -370 

5 


5  meters 196.850  inches. 

Liters  into  fluidounces,  multiply  by  33.815. 
Example:  33.815 

5 


5  liters    169.075  fluidounces. 

Grammes  into  grains,  multiply  by  15.432. 
Example:  15-432 

5 


5  grammes   77. 160  grains. 

Inches  into  centimeters,  multiply  by  2.539. 
Example:  2.539 

5 


5  inches 12.695  centimeters. 

Fluidounces  into  cubic  centimeters,  multiply  by  29.572. 
Example:  29.572 

5 


5  fluidounces   147.860  cubic  centimeters. 


PHARMACY  327 


TABLE  OF  EQUIVALENTS  —  Continued. 
Grains  into  grammes,  multiply  by  0.064. 
Example:  0.064 

5 


5  grams o.  320  gramme. 

Pharmacists  can  not  be  too  careful  in  the  use  of  metric  weights 
and  measures  in  the  writing  and  reading  of  prescriptions.  In 
Europe,  where  the  metric  system  has  been  in  use  for  many  years, 
no  signs  are  used  in  prescriptions,  because  all  ingredients,  whether 
solid  or  liquid,  are  weighed,  and  it  is  understood  that  weight  is 
always  intended;  whenever,  for  any  reason,  measures  are  wanted, 
the  signs  "  L."  (liter)  and  "  Ccm,"  (Cubic  centimeter)  are  em- 
ployed. But  in  this  country,  where  it  is  still  customary  to  weigh 
solids  and  to  measure  fluids  in  the  dispensing  of  medicines,  the 
official  abbreviations  given  in  the  U.  S.  Pharmacopoeia  should  be 
used  invariably,  so  as  to  avoid  all  possible  confusion.  With  water, 
and  the  average  diluted  alcohol  tinctures,  it  would  probably  not 
make  much  difference  whether  grammes  or  cubic  centimeters  were 
dispensed,  but  in  the  case  of  all  liquids  having  a  higher  or  lower 
specific  gravity  than  water  a  marked  variation  will  be  observed; 
thus  20  Cm.  of  glycerin  measure  16  Cc,  and  20  Cc.  of  glycerin 
weigh  25  Gm. ;  60  Gm.  of  simple  syrup  measure  45.5  Cc,  and  60  Cc. 
of  syrup  weigh  79.02  Gm. ;  30  Gm.  of  chloroform  measure  20.13  + 
Cc,  and  30  Cc.  of  chloroform  weigh  44.7  Gm. ;  4  Gm.  of  bromoform 
measure  only  1.4  Cc,  and  4  Cc  of  bromoform  weigh  11.32  Gm. ; 
10  Gm.  of  ether  measure  13.77  +  Cc,  and  10  Cc  of  ether  weigh 
only  7.26  Gm. ;  50  Gm.  of  alcohol  measure  60.97  +  Cc,  and  50  Cc 
of  alcohol  weigh  41  Gm. 

SCALES   AND   WEIGHTS 

The  most  useful  instrument  in  pharmacy  is  the  balance  or  scales. 
The  form  usually  employed  is  a  single  beam  with  equal  arms.  The 
beam  or  lever  is  divided  at  the  center  into  two  equal  arms  by  a  knife 
edge  upon  which  it  rests.  There  are  also,  at  each  end  of  the  beam, 
knife  edges  upon  which  the  scale  pans  are  suspended,  these  knife 
edges  being  hard  and  indestructible,  and  usually  of  agate. 


328    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

The  scale  pans  are  generally  of  nickel  or  silver,  but  for  weighing 
corrosive  substances  glass  scale  pans  are  employed. 

The  balance  should  be  enclosed  in  a  glass  case  and  carefully  pro- 
tected from  moisture,  corrosive  vapors,  dust,  and  from  jarring  and 
shaking.  They  should  be  kept  very  clean  by  polishing  with  leather 
and  dusting  with  a  camel's  hair  brush. 

Weights  are  usually  of  brass  or  aluminum,  and  platinum  is  also 
used  for  small  weights,  on  account  of  its  hardness  and  resistance  to 
corrosion. 

The  term  tare  denotes  the  weight  of  the  empty  vessel  or  container 
in  which  the  substance  is  to  be  weighed ;  gross  weight  includes  both 
the  substance  and  the  container,  while  net  weight  is  the  weight  o-f 
the  substance  alone. 

Measures  in  pharmacy  are  used  for  liquids  only;  they  are  ordi- 
narily glass,  and  are  known  as  graduates. 

Approximate  measurements.  The  number  of  drops  contained  in 
a  certain  volume  of  liquids  varies  according  to  its  density  and  the 
size  and  shape  of  the  vessel  from  which  it  is  dropped ;  they  are  not 
identical  with  the  minim. 

The  following  table  gives  certain  domestic  measures  and  their 
equivalents : 

One  teaspoonful         =  i  fluidrachm 
One  dessertspoonful  =  2  fluidrachms 
One  tablespoonful      =  ^  fluidounce 
One  wineglassful       =  2  fluidounces 
One  teacupful  =  4  fluidounces 

One  tumblerful  =  6  to  8  fluidounces 

According  to  the  U.  S.  Pharmacopoeia,  the  following  are  the 
metric  equivalents : 

One  teaspoonful  =  4  Cc. 
One  dessertspoonful  =  8  Cc. 
One  tablespoonful      =  16  Cc. 

FILLING   PRESCRIPTIONS 

(Extemporaneous  Pharmacy) 

This  includes  a  variety  of  operations,  and  requires  a  knowledge 
of  the  meaning  of  the  Latin  words  and  abbreviations  ordinarily 


PHARMACY  329 

used  in  prescription  writing,  as  well  as  great  care  and  accuracy  in 
the  various  steps  required. 

A  prescription  is  an  order  to  the  druggist  to  deliver  to  the  patient 
certain  medicines.  Such  orders  are  written  in  Latin,  this  language 
presenting  decided  advantages.  It  is  customary  to  have  so-called 
"prescription  blanks"  on  hand,  and  a  convenient  size  for  these  is 
three  and  one-half  inches  by  five  inches. 

Each  prescription  may  be  considered  to  be  composed  of  five 
parts : 

(i)  The  preliminaries. 

(2)  The  name  of  the  drug  or  preparation  ordered,  or  two  or 

more  of  such  names. 

(3)  The  quantity  of  such  ingredients. 

(4)  Directions  to  the  druggist  as  to  what  he  is  to  do  with  these 

ingredients. 

(5)  Directions  to  the  patient  as  to  how  the  medicine  is  to  be 

taken. 

(l)    THE    PRELIMINARIES 

Besides  the  portion  relating  to  the  compounding  and  dispensing 
of  the  medicine  ordered,  each  prescription  should  have  added  the 
name  and  address  of  the  prescriber,  the  name  of  the  patient  and 
the  date. 

The  address  may  be  written  or  printed  at  the  top  of  the  paper, 
and  is  to  be  followed  by  the  date,  just  as  in  writing  a  letter.  The 
name  of  the  patient  is  also  to  be  placed  above,  and  is  preceded  by 
"  For."  The  prescriber's  name  is  signed  below.  Should  any  special 
directions  to  the  druggist,  not  intended  to  be  put  upon  the  label 
attached  to  the  medicine,  be  added,  such  as  "  Not  to  be  repeated," 
"  To  be  repeated  once  only,"  etc.,  they  are  to  be  written  either  above 
or  below  the  main  subject  matter  of  the  prescription. 

(2)    THE  NAME  OF  THE  DRUG  OR  PREPARATION,  OR  TWO  OR  MORE 
OF   SUCH    NAMES 

Regarding  pharmacopoeial  nomenclature,  the  following  may  be 
noted : 

(a)  The  title  of  a  vegetable  drug  is,  with  few  exceptions,  its 
botanical  genus-name ;  it  is  represented  by  a  single  term,  unless  more 
than  one  part  of  the  plant  is  official,  in  which  case  the  part  of  the 
plant  desired  is  specified  in  addition.     Thus  we  say:   "Aconitum," 


330    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

because  only  the  root  is  official ;  but  "  Colchici  Radix  "  and  "  Colchici 
Semen,"  because  both  parts  are  official. 

{h)  Pharmacopocial  salts  are  usually  designated  by  the  Latin  of 
their  chemical  names,  with  the  basic  name  first  in  the  genitive,  fol- 
lowed by  the  acid  name  in  the  nominative.  Thus :  "  Magnesic 
Sulphate"  is  " Magnesii  Sulphas"  i.  e.,  "of  Magnesium,  the 
Sulphate."  In  a  few  instances,  the  common  names  are  employed 
instead  of  the  chemical  ones,  as  "Alumen  "  for  "  Potassio-aluminum 
sulphate."  When  tivo  classes  of  the  same  salt  are  employed,  one  is 
distinguished  from  the  other  by  a  difference  in  nomenclature  (i) 
chemically,  such  as  "  Sodii  Carbonas "  and  "  Sodii  J5ica.rbonas," 
"  Liquor  Ferri  ^'w&sulphatis  "  and  "  Liquor  Ferri  T^rsulphatis  " ;  or 
(2)  by  some  reference  to  their  physical  or  physiological  qualities, 
such  as  "  Hydrargyri  Chloridum  Corrosivum "  and  "  Hydrargyri 
Chloridum  Mite,"  Hydrargyri  Oxidum  Flavum  and  Hydrargyri 
Oxidum  Rubrum. 

(c)  Adjectives  follow  the  nouns  which  they  qualify;  thus: 
"  Cinchona  Flava,"  "  Yellow  Cinchona."  When  two  nouns  occur 
together  in  drugs  and  chemicals  (not  in  preparations),  the  genitive 
following  "of"  is  placed  first;  thus:  "  Belladonnse  Radix,"  "Of 
belladonna,  the  root. 

Each  ingredient  of  a  prescription  is  to  be  in  the  genitive  case, 
since  it  follows  "  Recipe."  We  say :  "  Take  of  so  and  so  certain 
quantity."     The  only  exceptions  to  this  rule  are  the  following: 

(o)  When  we  order  a  definite  number  or  size  of  any  pharma- 
copoeial  preparation,  the  latter  is  to  be  in  the  accusative  case,  since 
it  is  now  the  direct  object  of  "Recipe."  Thus  we  say:  "Take 
twelve  Compound  Cathartic  Pills,"  "  Recipe  Pilulas  Cartharticas 
Compositas,  numero  xij."  Again :  "  Take  a  Belladonna  Plaster 
six  inches  by  four  inches "  is  "  Recipe  Emplastrum  Belladonnse 
six  inches  by  four  inches."  But  if  we  directed  the  druggist  to 
"  take  a  certain  quantity  of  Belladonna  Plaster,  and  then  to  spread 
this  upon  adhesive  plaster,"  we  would  write :  "  Recipe  Emplastri 
Belladonnae,  3  ij.;  extende  supra  emplastrum  resinae,  six  inches  by 
four  inches." 

(&)  When  we  have  ordered  one  or  more  ingredients,  and  wish  to 
add  enough  water  or  other  liquid,  so  as  to  give  a  desired  hulk,  with- 
out stopping  to  compute  the  exact  amount  necessary,  we  may  order 


PHARMACY  331 

the  final  ingredient  in  the  following  manner :  "  Take  Water  up  to 
a  cretain  quantity."  Here  "  water  "  would  be  the  direct  object  of 
"  Recipe,"  and  thus  be  in  the  accusative  case,  thus :  "  Recipe,  Aquaw, 
ad  fl.  §  iv."  The  latter  phrase  can  also  be  rendered :  "  Take  of 
Water  a  sufficient  quantity  up  to  four  fluidounces."  "  Recipe, 
Aqu^,  quantum  sufficiat  ad  fl.  §  iv." 

THE   QUANTITY  OF   THE   INGREDIENTS 

These  are  placed  in  the  accusative  case,  being  the  direct  object 
of  "  Recipe ; "  but  it  is  not  only  customary,  but  is  advisable  to 
express  quantities  in  symbols  and  not  to  write  them  out. 

The  cardinal  numerals  are  usually  represented  by  the  Roman 
symbols :  i.,  ii.,  iii.,  iv.,  etc.  It  is  customary  to  draw  a  line  over  the 
symbol  and  to  dot  the  I.  This  is  an  additional  safeguard  against 
mistakes,  since  the  number  of  dots  should  correspond  to  the  number 
of  I's;  when  the  symbol  I  is  final,  it  is  usually  modified,  and  the 
fact  of  its  being  the  final  number  indicated  by  changing  it  into  a 
«j''_thus  "j." 

DIRECTIONS  TO   THE   DRUGGIST 

as  to  what  he  is  to  do  with  the  ingredients  which  have  been 
ordered : 

These  begin  with  the  I^,  the  abbreviation  of  "recipe,"  at  the 
commencement  of  every  prescription.  The  ingredients  and  quanti- 
ties also  apply  to  him,  for  he  is  directed  to  take  those  different 
substances  in  specified  quantities. 

Where  a  certain  number  or  certain  quantity  of  an  official  prepara- 
tion is  ordered,  there  may  be  no  further  directions  for  the  druggist 
except  "  Signa,"  "  Label,"  and  then  the  directions  to  the  patient. 

But  where  two  or  more  ingredients  are  combined,  after  enumerat- 
ing these,  we  direct  the  druggist  to  mix  — "  Misce."  In  the  case 
of  all  preparations  excepting  pills,  powders,  suppositories,  and 
troches,  this  would  be  all  that  would  be  necessary.  But  it  is  a  little 
more  elegant  to  add  "  Fiat ,"  mentioning  the  form  of  medi- 
cine which  we  have  prescribed,  the  name  of  the  medicine  being  in 
the  nominative  singular,  after  the  passive  imperative  "  Fiat ; "  thus : 
"  Fiat  mistura,"  "  Fiat  linimentum,"  "  Fiat  unguentum,"  "  Fiat 
collyrium,"  etc. 

In  the  case  of  pills,  suppositories,  and  troches,  we  direct  the 


332    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

druggist  to  "  make  a  mass  and  to  divide  it  into  a  certain  number  of 
pills,  suppositories,  or  troches.  This  we  may  express  in  either  of 
the  following  ways: 

(i)  Fiat  massa,  et  divide  in  pilulas  (suppositoria,  trochiscos) 
numero . 

(2)   Fiat  massa,  in  pilulas  (suppositoria,  trochiscos),  numero 

dividenda. 

"  Pilulas,"  "  suppositoria,"  and  "  trochiscos  "  being  in  each  case 
in  the  accusative  plural  after  the  preposition  "in."  "Dividenda" 
always  agrees  -with  "  massa." 

In  the  case  of  a  powder  which  is  to  be  divided  into  a  certain 
number  of  papers,  we  direct  the  druggist  to  "  make  a  powder  and  to 
divide  this  into  a  certain  number  of  papers"  and  again  we  have  two 
methods  of  expressing  this : 

(i)   Fiat  pulvis,  et  divide  in  chartulas  numero  — '■ — . 

(2)   Fiat  pulvis,  in    chartulas   numero   dividendus. 

Here  we  say  "  dividendwj,"  to  agree  with  "  pulvis." 

It  is  quite  common  in  Europe  to  order  a  single  dose  of  a  powder, 
pill,  troche,  or  suppository,  and  then  to  direct  the  druggist  to  "  make 
of  such  doses  a  certain  number."  This  method  is  occasionally  em- 
ployed in  this  country,  and,  then,  supposing  we  wished  twenty  papers 
of  Dover's  powder  each  weighing  five  grains,  we  would  write  for : 
Recipe : 

Pulveris  Ipecacuanhge  et  Opii gr.  v. 

Fiat  chartulse  tales  doses  numero  xx.,  or  we  may  also  say:  Fac 
chartulas  tales  doses  numero  xx. ;  in  this  case,  "  chartulas  "  is  in  the 
accusative  plural  after  "  fac." 

In  ordering  pills,  it  is  not  necessary  for  us  to  specify  the  sub- 
stances which  are  to  be  used  in  making  a  pilular  mass ;  this  belongs 
to  the  pharmacist.  Very  often,  however,  the  substances  ordered  in 
pills,  such  as  extracts,  are  themselves  all  that  are  necessary  for 
making  a  suitable  pill  mass. 

Next,  we  direct  the  druggist  to  "label"  — "  Signa." 
Other  Latin  words  and  phrases  used  in  prescriptions  are  the 
following : 

A'dde,  add. 

Ad  li'bitum,  at  pleasure. 

Ad  satura'ndum,  to  saturation. 

Be'ne,  well. 


PHARMACY  333 

Ana,  ad,  of  each. 

Bis;  twice. 

Bis  in  di'es,  twice  daily. 

Bu'lliat,  let  (it)  boil. 

Ci'hus,  food. 

Cochlea're  ma'gnum,  a  tablespoon. 

Cochlea're  parvum,  a  teaspoon. 

Co'la,  strain. 

Colluto'rium,  a  mouth-wash. 

De'in,  thereupon. 

Dimi'dius,  half. 

Di'vide,  divide. 

Do'sis,  a  dose. 

Et,  and. 

Exte'nde,  spread. 

Exte'nde  su'pra,  spread  upon. 

Fac,  make. 

Fi'at  (sing.),  Fi'ant  (plur.),  let  (it,  them)  be  made  (into). 

Fi'ltra,  filter. 

Grada'tim,  gradually. 

Gu'tta,  a  drop. 

Gutta'tim,  drop  by  drop. 

Ho'ra,  an  hour. 

In  di'es,  daily. 

Lage'na,  a  bottle. 

Li'hra,  a  pound. 

Li'nteum,  lint. 

Ma'cera,  macerate. 

Ma'ne,  in  the  morning. 

Ma'ne  pri'mo,  early  in  the  morning. 

Mica  pa'nis,  a  crumb  of  bread. 

Mi' see,  mix. 

Non,  not. 

No'cte,  at  night. 

No'cte  mane'qiie,  at  night  and  in  the  morning. 

Nu'merus,  a  number. 

Nu'mero,  in  number. 

Octa'rius,  a  pint. 

Pa'rtes  cequa'les,  equal  parts. 


334    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

Pro  re  na'ta,  as  required. 

Qua'ntum  sufficiat,  as  much  as  is  necessary.   ♦ 

Qua'qua  ho'ra,  every  hour. 

Re'cipe,  take. 

Satura'tus,  saturated. 

Sca'tula,  a  box. 

Se'mel,  once. 

Semissis,  a  half. 

Semidra'chma,  a  half  drachm. 

Si'gna,  mark. 

Si'mul,  together. 

Si'ne,  without. 

So'lve,  dissolve. 

Sta'tim,  immediately. 

Suffi'ciat,  may  suffice. 

Ta'les,  such. 

Ta'les  do'ses,  such  doses. 

Te're,  rub. 

Te're  si'mul,  rub  together. 

Ter  in  di'e,  three  times  a  day. 

Tri'tura,  triturate. 

5.   DIRECTIONS   TO   THE    PATIENT 

These  are  to  be  written  in  English,  and  are  to  be  definite.  The 
words  "  as  directed,"  having  absolutely  no  value,  are  never  to  be 
employed.  No  greater  proof  of  the  uselessness  of  these  words  can 
be  given  than  to  state  that  when  a  prescription  is  sent  out  without 
directions,  druggists  are  in  the  habit  of  labelling:  "  Use  as  directed." 

Compounding  means  the  preparation  of  the  various  drugs  ordered, 
while  dispensing  includes  putting  them  up  and  issuing  them. 

To  fill  a  prescription,  first  read  it  over  carefully  until  it  is  thor- 
oughly understood,  then  number  it,  and  write  the  label;  next  meas- 
ure out  the  ingredients,  checking  each  one  off  to  prevent  duplication, 
compound  them  as  directed,  and  dispense.  Poisonous  prescriptions 
should  be  plainly  labeled  Poison.  The  prescription  should  then  be 
filed  in  the  prescription  book. 

Prescriptions  should  not  be  refilled  without  an  order  from  a  med- 
ical officer  in  each  case;  the  date  refilled  should  be  noted  on  the 
prescription  and  on  the  label. 


PHARMACY  335 

INCOMPATIBILITY 

Incompatibility  of  drugs  means  unfitness  for  combination  in  the 
same  prescription.  Incompatibility  may  be  chemical,  pharmaceuti- 
cal, or  therapeutical. 

.  In  chemical  incompatibility  a  chemical  reaction  takes  place  result- 
ing in  the  formation  of  precipitates,  explosives,  or  poisonous  com- 
pounds. Combination  of  cinchona  preparations  with  salts  of  iron 
forms  an  inky  mixture;  of  nitric  acid  with  glycerin  an  explosive 
substance;  of  dilute  hydrocyanic  acid  with  calomel  a  virulent 
poison. 

In  pharmaceutical  incompatibility  no  chemical  action  takes  place, 
but  precipitation  and  an  unsightly  mixture  often  results ;  the  addition 
of  aqueous  solutions  to  resinous  tinctures  illustrates  this  principle. 

Therapeutical  incompatibility  arises  when  two  agents  which  oppose 
each  other  in  their  action  on  the  system  are  prescribed  together, 
such,  for  example,  as  morphine  and  atropine.  It  is  always  to  be 
borne  in  mind,  however,  that  chemically  or  therapeutically  incom- 
patible drugs  are  often  prescribed  together  intentionally  to  serve  a 
definite  purpose. 

It  will  be  well  to  mention  certain  underlying  principles  which 
should  be  considered  when  we  order  mixtures  of  two  or  more 
remedial  agents. 

1.  Water  is  the  solvent  usually  employed  for  soluble  salts,  for 
acids,  sugars,  gums,  vegetable  extractive  matters,  and  for  albuminous 
and  gelatinous  compounds. 

2.  Alcohol  is  usually  employed  for  dissolving  volatile  oils,  oleo- 
resins,  resins,  gum-resins,  camphor,  balsams,  and  vegetable  sub- 
stances containing  oily  and  resinous  principles. 

3.  When  more  than  a  small  amount  of  such  aqueous  solutions  are 
added  to  alcoholic  solutions,  or  vice  versa,  a  precipitation  of  previ- 
ously dissolved  principles  often  ensues,  and  an  unsightly  or  other- 
wise undesirable  mixture  results.  This  is,  however,  not  always  the 
case,  for  the  substance,  which  is  dissolved  in  the  alcohol,  may  also  be 
soluble  in  water,  or  may  be  soluble  in  a  mixture  of  alcohol  and 
water,  and  thus  no  change  will  occur. 

4.  Free  acids  unite  with  bases  forming  salts. 

5.  Strong  acids  and  bases  (such  as  inorganic  acids,  lead,  mercury) 
displace  weaker  acids  and  bases  (such  as  organic  acids,  potassium, 
lithium). 


336    MATERIA  MEDICA,  THERAPEUTICS,  PHARMACY 

6.  Salts  in  solution  exchange  acids  or  bases,  if,  by  so  doing,  a 
precipitate  can  be  formed. 

7.  The  occurrence  of  an  apparent  incompatibility,  such  as  a  pre- 
cipitate in  a  solution,  may  be  desirable,  as  in  the  cases  of  black  and 
yellow  washes  (made  by  adding  calomel  and  corrosive  sublimate 
respectively  to  lime  water)  ;  here  this  fact  should  be  made  known 
by  adding  to  the  directions  on  the  bottle  that  the  mixture  is  to  be 
shaken  before  using, 

8.  Agents  rich  in  Oxygen  (oxidising)  when  mixed  in  concentrated 
form  zi'ith  readily  oxidisable  substances  may  cause  explosions. 
Hence  Potassic  Chlorate  and  Permanganate,  strong  Nitric,  Nitro- 
hydrochloric,  and  Chromic  Acids  (all  powerful  oxidizing  agents) 
should  not  be  mixed  with  dry  vegetable  powders,  Tannic  Acid, 
Sugars,  Glycerin,  Alcohol,  tinctures.  Ether,  Sulphur,  and  Phos- 
phorus. 

9.  A  drug  should  never  be  prescribed  with  any  of  its  tests  or 
antidotes. 

TABLE  OF   MOST   IMPORTANT   MUTUALLY   PRECIPITANT  SOLUTIONS 


P.  =  precipitate                                ig  ^'-^  .  °  'o  ^«'^sgsg.«-Sg 

-;«  .*;«  .*;  .*i  .-a     .  tr    ^  -ri  S  Z  ^  be  ^ 

5.2  3   rt  i-,  3   M  5  m  3  C     3  Ji    3  ^     ^-S    c   ^'C 

Solutions    of    Alkalies P.  P.  P,  P.  P.     P.                     P. 

Tannic  Acid  and  Vegetable  Astringents P.  P.  P.  P.  P.              P.     P. 

Solutions  of   Carbonates P.  P.  P.  P.  P.     P. 

Solutions  of  Sulpliates  and  Sulphuric  Acid P.  P.  P. 

Solutions  of  Phosphates  and  Phosphoric  Acid..     P.  P.  P.  P,  P.     P. 

Solutions  of  Borax  and   Boric   Acid P.  P.  P.  P.  P. 

Solutions  of  Chlorides  and  Hydrochloric  Acid..  P.  P. 

Solutions   of  Bromides  and  ITydrobromic  Acid.  P.  P. 
Solutions    of    fodides,    of    Iodine,    and    Syrupus 

Acid   Hydriodici P.  P-  P. 

Solutions  of  Sulphides  and  Sulphurous  Acid...      P.  P.  P.  P.  P.     P. 

Arsenical    Solutions    P.  P-  P-  P-  P-     P. 

Albuminous  Solutions   P.  P-  P- 


PART  VII 

HYGIENE.     POST  AND  CAMP  SANITATION 


CHAPTER   I 


WATER 

The  amount  of  water  needed  by  the  average  man  daily  for  drink- 
ing purposes  varies  according  to  the  amount  of  exercise  he  takes  and 
the  temperature  of  the  atmosphere;  a  fair  average  is  three  or  four 
pints  in  addition  to  that  which  he  takes  in  food.  On  the  march  the 
amount  is  Hmited  by  the  capacity  of  the  canteen  to  about  one  quart, 
and  this  quantity  should  be  very  carefully  husbanded. 

The  total  daily  allowance  in  the  field  is  usually  calculated  at  about 
two  gallons  per  man;  four  and  one-half  quarts  for  drinking  and 
cooking,  two  and  one-half  for  washing,  and  one  quart  for  wastage. 

Waters  are  usually  divided  into  two  classes :  surface  waters  and 
ground  waters.  The  former  include  rain,  river,  lake,  and  pond 
waters,  and  the  latter  well  and  deep  spring  waters. 

A  water  is  said  to  be  potable  when  it  is  fit  to  drink.  A  potable 
water  is  an  uncontaminated  water ;  no  matter  how  clear,  bright,  and 
sparkling  a  water  may  be,  it  is  not  potable  if  it  is  so  situated  that  it 
can  be  fouled  by  fecal  matter,  urine,  or  the  drainage  from  manured 
lands.  There  is  a  very  common  error  that  all  spring  water  is  pure ; 
many  springs,  especially  those  which  are  not  constantly  flowing,  draw 
their  water  from  surface  sources. 

Water  from  deep  wells  is  usually  safe ;  from  shallozv  wells  suspi- 
cious. Whether  a  well  is  to  be  considered  a  deep  or  shallow  well 
depends  upon  whether  or  not  it  passes  through  an  impervious  layer 
of  rock  or  clay  so  that  surface  drainage  cannot  get  into  it;  if  it 
passes  through  such  a  layer  it  is  a  deep  well ;  if  it  does  not  it  is  a 
shallow  well. 

Though  rain  water  is  originally  pure,  cistern  water  may  be  very 
22  (337) 


338       HYGIENE.     POST  AND  CAMP  SANITATION 

impure;  the  impurities  come  from  the  washings  of  the  roof  from 
which  it  is  collected,  from  dust  blown  into  it,  and  if  it  is  an  under- 
ground cistern,  there  may  be  a  crack  through  which  surface  drainage 
may  enter. 

Hard  water  is  water  that  will  not  lather  well  with  soap ;  the  hard- 
ness is  due  to  lime  salts  and  may  be  partially  removed  by  boiling; 
well  water,  especially  deep  well  water,  is  usually  hard. 

Ice  has  tne  same  impurities  as  the  water  from  which  it  is  made; 
therefore  natural  ice  is  often  impure.  Ice  made  from  distilled  water 
is  usually  very  pure. 

Water  may  he  purified  in  three  ways:  by  chemical  treatment,  by 
boiling  or  distillation,  and  by  filtration.  The  first  two  methods  are 
usually  applied  to  limited  supplies,  while  the  last  is  applicable  on  a 
large  scale. 

Chemical  treatment:  The  simplest  form  of  chemical  treatment  is 
the  use  of  alum,  about  a  third  of  a  gramme  to  the  gallon,  thoroughly 
stirred  in  the  water,  which  is  then  allowed  to  settle.  The  alum 
causes  a  bulky  precipitate,  which  in  falling  carries  down  with  it  most 
of  the  suspended  matter,  including  the  bacteria. 

Permanganate  of  potash  is  useful  in  quantities  of  one  or  two 
grains  to  the  gallon,  or  just  enough  to  give  the  water  a  faint  tinge. 
Iodine  may  be  used,  three-quarters  of  a  grain  to  a  gallon,  or  tinc- 
ture of  iodine  added  to  the  water  until  it  acquires  a  faint  yellow 
tinge.  The  taste  and  color  of  the  iodinized  water  may  be  destroyed 
by  the  addition  of  three-quarters  of  a  grain  each  of  hyposulphite  of 
soda  and  citric  acid  or  tartaric  acid. 

Both  iodine  and  permanganate  act  on  the  same  principle  as 
chlorine. 

Chlorinated  lime  is  a  very  valuable  water  sterilizer;  it  is  used 
both  for  general  water  supplies  and  individually  in  the  form  of 
tablets  for  soldiers  on  the  march.  Its  destructive  efifect  on  bacteria 
is  due  to  the  action  of  the  oxygen  set  free  when  the  chlorine  com- 
bines with  the  hydrogen  of  the  water. 

A  very  useful  appliance  for  utilizing  the  bactericidal  effect  of 
chlorine  and  water  has  recently  been  devised  by  Major  Wm.  J. 
Lyster,  Medical  Corps,  for  use  in  the  field.  It  consists  of  a  canvas 
bag  of' specially  woven  flax,  of  sufficient  capacity  to  supply  a  com- 
pany of  infantry  at  war  strength  with  a  canteen-full  of  water  for 
each  officer  and  man.     This  bag  at  the  opening  is  sewn  over  a  gal- 


WATER  339 

vanized  iron  ring,  hinged  at  one  diameter,  which  permits  the  bag 
to  be  folded.  It  is  supported  when  in  use  by  two  pieces  of  hemp 
rope,  3  feet  2  inches  in  length,  spliced  to  the  ring  at  points  equi- 
distant. The  bag  is  fitted  with  five  self-closing  faucets  just  above 
the  bottom  seam,  spaced  at  equal  intervals.  This  gives  a  container 
that  weighs  about  seven  and  one-half  to  eight  pounds,  that  can  be 
folded  up  into  a  convenient  and  readily  portable  package  not  too 
large  or  heavy  to  be  carried  over  the  infantry  pack.  Sufficient 
chemical  can  be  carried  in  sixty  glass  tubes  to  supply  an  infantry 
company  at  war  strength  with  five  canteens  of  water  a  day  per 
capita  for  twelve  days.  Such  a  package  of  these  tubes  weighs  ten 
ounces  and  measures  6^  x  3^  x  2^  inches. 

Under  ordinary  circumstances  this  bag,  when  filled  with  water, 
will  have  its  contents  rendered  safe  in  about  five  minutes.  After 
the  bag  has  been  filled  with  water,  the  calcium  hypochlorite  con- 
tained in  one  tube,  which  is  easily  broken  in  the  hands  at  the  point 
marked  by  a  file,  may  be  shaken  directly  onto  the  surface  of  the 
water,  or  it  may  be  added  to  a  small  amount  of  water  in  any  ordi- 
narily clean  container  and  poured  directly  into  the  water  in  the  bag ; 
no  stirring  is  necessary. 

As  the  oxidation  of  organic  matter  in  water  through  the  agency 
of  hypochlorite  proceeds  best  in  clear  water,  it  is  desirable  to  remove 
fine  clay  and  other  comparatively  coarse  matters  before  introducing 
the  hypochlorite.  It  is  probable  that  in  the  field  many  surface 
waters  will  carry  suspended  matter  to  an  extent  that  may  interfere 
slightly  with  the  hypochlorite  process.  To  reduce  this  matter  in 
amount,  a  piece  of  Scotch  outing  flannel  is  used.  This  cloth,  weigh- 
ing one  ounce,  is  fastened  by  tapes  sewn  to  it  to  the  ropes  by  which 
the  bag  is  suspended,  so  it  almost  covers  the  opening  of  the  bag. 
Through  this  cloth  the  water  is  poured  in  filling  the  bag.  In  the 
hands  of  a  medical  officer  or  instructed  non-commissioned  officer  of 
the  hospital  corps,  the  starch  iodine  reaction  gives  exact  information 
as  to  whether  sufficient  hypochlorite  is  being  used.  As  iodine  and 
starch  are  at  hand  in  the  field,  we  have  -a  practical  method  of  control. 

Boiling  and  filtration  are  also  applicable  in  the  field.  One  min- 
ute's active  boiling  is  sufficient  to  destroy  all  the  bacteria  of  water- 
borne  diseases;  it  does  not,  however,  clear  water  nor  remove  dis- 
solved organic  matter. 

As  it  removes  the  gases  of  water  it  becomes  flat  to  the  taste,  and 


340       HYGIENE.    POST  AND  CAMP  SANITATION 

must  be  aerated  before  use,  but  this  is  easily  accomplished  by  shak- 
it  up,  or  pouring  from  one  vessel  to  another.  To  make  the  water 
palatable  it  must  also  be  cooled. 

Distillation  is  an  efficient  process  of  sterilizing  water,  but  if  the 
water  is  taken  from  a  very  polluted  source  offensive  gases  may  pass 


1 

^^^H|i    1 

Fig.  222. —  Darnall  Filter.     Set  up  ready  for  use. 

over  in  sufficient  quantity  to  cause  a  disagreeable  taste  and  perhaps 
diarrhea. 

Filtration  is  a  process  requiring  constant  care  and  supervision. 
Individual  or  barrack  filters,  while  they  clear  the  water,  are  liable  to 
increase  rather  than  diminish  the  number  of  bacteria.  Unless  such 
filters  are  in  perfect  condition  and  frequently  sterilzed  the  bacteria 


WATER 


341 


grow  into  the  substance  of  the  filter,  which  finally  becomes  a  culture 
medium. 

The  Darnall  Siphon  filter,  from  which  very  satisfactory  results 
have  been  reported,  combines  precipitation  zcnth  filtration,  and  pro- 
vides for  maintaining  the  bacterial  efficiency  of  the  filtering  mate- 
rials. The  precipitant  used  is  a  combination  of  alum  and  soda 
known  as  hydroxide  powder. 

The  apparatus  arranged  ready  for  use  is  shown  m  Fig.  222. 

Improvised  filters  intended  only  to  clear  muddy  water  are  readily 
prepared.  The  simplest  form  is  that  so  common  in  tropical  coun- 
tries, a  small  hole  being  dug  in  the  sand  near  the  edge  of  a  stream, 
the  water  filtering  through  the  intermediate  sand  or  being  caught  on 
its  way  to  the  stream. 

Another  simple  method  is  to  take  two  barrels  of  different  sizes, 
bore  holes  in  the  bottom  of  the  larger  and  near  the  top  of  the 


COARSE  CRAVEL 

CHARCOAL 

SAND 

MOSS 


COARSE  ORAVEL 
CHARCOAL 


Fig.   223. — Improvised  Filter.  Fig.   224. — Improvised  Filter. 

smaller,  place  the  smaller  barrel  inside  the  larger,  fill  in  the  inter- 
vening space  with  sand  and  sink  both  in  the  water  (Fig.  223).  Or 
the  larger  barrel  may  be  left  intact,  holes  being  bored  in  the  bottom 
of  the  smaller,  and  the  water  being  poured  in  on  the  sand  between 
the  barrels  (Fig.  224).  Sand  used  for  such  purposes  should  always 
be  washed  and  if  possible  sterilized  before  use,  and  this  process 
should  be  frequently  repeated  during  use. 

Impure  water  may  cause  disease  in  several  ways.  Hard  water  or 
water  containing  mineral  salts  often  causes  diarrhea,  constipation,  or 
indigestion  in  those  unaccustomed  to  its  use.  Decomposing  vegeta- 
ble or  animal  matter  in  water  or  the  presence  of  living  algae  may  also 
cause  diarrhea  and  indigestion,  but  the  great  danger  in  the  use  of 


342       HYGIENE.     POST  AND  CAMP  SANITATION 

polluted  water  is  the  liability  to  swallow  the  germs  of  certain  special 
diseases,  notably  typhoid  fever,  cholera,  and  dysentery.  Great 
epidemics  have  been  traced  directly  to  the  use  of  water  fouled  by 
the  discharges  from  patients  afflicted  with  those  diseases. 

A  great  many  intestinal  parasites,  round  worms,  pin  worms,  etc., 
are  also  carried  by  impure  water. 

Hospital  corps  men  should  know  how  to  take  samples  of  water  for 
analysis.  For  chemical  analysis  not  less  than  three  liters  are  neces- 
sary; for  bacteriological  test  about  200  cubic  centimeters  are  re- 
quired. Samples  should  be  collected  in  perfectly  clean  glass  bottles 
stoppered  with  glass  or  clean  new  cork;  if  for  bacteriological  pur- 
poses, the  bottle  must  be  sterilized.  If  taken  from  a  tap,  water 
enough  must  be  allowed  to  waste  to  empty  the  branch  pipes;  if  from 
a  pump,  the  barrel  must  be  emptied;  if  from  a  pond,  the  sample 
must  be  taken  from  below  the  surface  and  at  some  distance  from 
shore. 


CHAPTER   II 

AIR  AND  VENTILATION 

As  we  have  already  seen,  air  is  a  mixture  of  oxygen,  nitrogen, 
carbonic  acid,  and  watery  vapor.  Oxygen  is  the  element  that  sup- 
ports all  animal  life;  it  is  being  constantly  withdrawn  from  the  air 
in  the  processes  of  respiration  and  combustion,  and  returned  to  it, 
combined  with  carbon,  as  carbonic  acid.  Vegetable  life  takes  up  the 
carbonic  acid  and  decomposes  it,  retaining  the  carbon  and  returning 
the  free  oxygen  to  the  air,  so  that  the  equilibrium  is  maintained. 

Watery  vapor  is  a  normal  constituent  of  air,  and  the  higher  the 
temperature  of  the  air  the  more  it  is  capable  of  holding ;  when  it  will 
hold  no  more  the  air  is  said  to  be  saturated.  If  air  so  saturated 
meets  with  a  cooler  stratum  the  excess  of  moisture  is  precipitated  as 
rain  or  dew.  Humidity  refers  to  the  amount  of  watery  vapor  in 
air;  relative  humidity  is  the  degree  of  approach  to  saturation  at  any 
given  temperature,  while  absolute  humidity  is  the  actual  weight  of 
the  moisture  in  a  given  quantity  of  air. 

The  impurities  of  air  with  which  we  have  to  deal  in  dwellings  are 
dust  and  bacteria,  organic  matter,  and  undue  proportion  of  carbonic 
acid.  The  organic  matters  are  particles  of  epithelium  and  the  vola- 
tile products  from  the  lungs  and  skin,  from  unclean  mouths,  noses, 
and  the  intestinal  tract;  in  hospitals  there  are  also  pus  cells  from 
suppurating  wounds,  and  the  bacteria  of  infectious  diseases.  The 
effects  of  overcrowding  and  vitiated  air  are  well  known ;  immedi- 
ately they  are  headache,  dizziness,  and  loss  of  appetite ;  when  long 
continued,  there  is  loss  of  bodily  vigor  and  diminished  resistance  to 
disease. 

Besides  these  indirect  effects  of  vitiated  air  many  diseases  are 
directly  caused  by  the  inhalation  of  bacteria  from  the  air;  among  the 
most  important  air-borne  diseases  are  tuberculosis,  pneumonia,  ery- 
sipelas, and  possibly  the  eruptive  fevers. 

The  pollution  of  air  in  dwellings  is  caused  not  only  by  the  exhala- 
tions from  the  human  body,  but  also  by  the  products  of  combustion  in 

(343) 


344       HYGIENE.     POST  AND  CAMP  SANITATION 

heating  and  lighting.  It  is  estimated  that  an  ordinary  five-foot  gas 
burner  when  in  use  adds  to  the  air  of  the  apartment  fully  as  much 
carbonic  acid,  besides  other  impurities,  as  one  man. 

The  process  by  which  the  vitiated  air  of  dwellings  is  removed  and 
replaced  or  diluted  by  fresh  air  is  known  as  ventilation. 

For  the  maintenance  of  the  human  body  in  a  fair  degree  of  health 
and  vigor  it  has  been  found  that  about  three  thousand  cubic  feet  of 
fresh  air  per  hour  must  be  supplied  each  person.  The  size  of  the 
air  space  which  must  be  provided  for  each  person  depends  upon  the 
possibility  of  supplying  this  amount  of  air  without  causing  draughts ; 
if  the  entering  air  is  warm,  draughts  of  course  are  not  felt  so  much 
as  if  it  is  cold. 

As  a  matter  of  experience  it  has  been  found  that  even  when 
warmed  the  air  of  a  room  under  the  most  favorable  circumstances 
can  not  be  changed  more  than  three  or  four  times  an  hour  without 
causing  a  sensation  of  draught ;  so  that  the  minimum  cubic  air  space 
per  man  should  be  at  least  one  thousand  feet,  which  with  three 
changes  per  hour  will  give  the  necessary  three  thousand  cubic  feet 
of  fresh  air;  in  the  tropics  the  minimum  cubic  air  space  should  be 
two  thousand  feet,  with  a  floor  space  of  not  less  than  one  hundred 
square  feet.  In  computing  the  cubic  air  space  in  a  room  we  multiply 
the  length  by  the  breadth  and  then  by  the  height  of  the  room,  or  by 
twelve  if  the  height  is  greater  than  twelve  feet.  The  reason  we  do 
not  ordinarily  count  height  above  twelve  feet  is  because  above  that 
height  there  is  very  little  movement  of  the  air  in  the  room  unless 
there  are  special  arrangements  for  its  change. 

The  floor  space,  therefore,  should  be  not  less  than  one-twelfth  of 
the  cubic  space. 

In  hospitals,  owing  to  the  additional  impurities  from  the  sick,  four 
thousand  cubic  feet  of  fresh  air  per  man  per  hour  should  be  allowed, 
the  floor  space  should  not  be  less  than  one  hundred  square  feet  and 
the  cubic  space  not  less  than  twelve  hundred  feet  in.  temperate 
climates,  and  50  per  cent  more  in  the  tropics. 

The  agencies  concerned  in  ventilation  are  diffusion,  and  gravity  or 
weight.  Diffusion  is  not  of  much  value  and  can  not  be  relied  upon 
alone ;  the  important  agent  is  gravity.  Equal  volumes  of  air  of  the 
same  temperature  and  under  the  same  pressure  have  equal  weights ; 
now  if  one  of  the  volumes  is  heated  it  expands  and  becomes  lighter, 
and  being  surrounded  by  heavier  air,  rises,  or  rather  is  forced  up. 


AIR  AND  VENTILATION 


345 


by  the  sinking  of  the  heavier  air,  and  thus  currents  are  produced. 
When  the  air  in  a  room  is  heated  by  fire,  lights,  or  even  the  human 
body,  it  becomes  Hgher,  and  the  heavier  outside  air  forces  itself  in 
through  all  the  openings  and  crevices,  at  the  same  time  forcing  the 
lighter  air  out,  thus  effecting  a  certain  amount  of  ventilation. 

Unequal  temperatures  in  masses  of  air  outside  dwellings  give  rise 
to  winds,  and  winds  aid  ventilation  in  two  ways :  First,  by  perflation, 
or  blowing  through  a  room  when  the  windows  are  open,  and  second, 
by  aspiration  when  it  blows  across  chimneys  or  flues. 

Ventilation  of  a  dwelling  is  said  to  be  either  natural  or  mechanical ; 
natural  when  we  trust  to  the  forces  of  nature,  merely  providing  the 


Fig.  225. —  Heating  and  Ventilation  by  Jacketed  Stove. 

necessary  entrance  and  exit  openings,  together  with  heat  if  required; 
mechanical  when  the  air  is  forced  in  or  drawn  out  by  fans  or  other 
mechanical  means. 

In  any  system  .it  is  necessary  to  remember  that  it  requires  two 
openings  to  secure  ventilation ;  if  only  one  opening  is  provided,  the 
incommg  and  outgoing  currents  interfere  with  each  other  and  venti- 
lation fails.  This  is  well  illustrated  by  the  familiar  experiment  of 
burning  a  candle  inside  of  an  unstoppered  bottle;  if  the  opening 
into  the  btotle  is  divided  into  two  parts  by  a  partition,  the  candle 
will  burn,  because  the  air  currents  pass  up  one  side  of  the  partition 


346       HYGIENE.     POST  AND  CAMP  SANITATION 


and  down  the  other  without  interference;  if  the  partition  is  removed 
the  light  goes  out. 

Ventilation  in  summer  or  in  hot  climates  is  largely  a  matter  of  the 
action  of  winds,  because  the  temperature  of  inside  and  outside  air  is 
practically  the  same,  so  that  we  merely  leave  doors  and  windows 
open,  and  provide  special  openings  in  the  ridge  or  under  the  eaves 
for  the  escape  of  the  heated  air  in  the  upper  parts  of  the  building. 
Or  fans  are  provided  to  keep  the  air  in  motion ;  and  such  devices  as 
the  punkah  or  electric  fans. 

In  winter  the  subject  of  ventilation  is  so  intimately  connected  with 
that  of  heating  that  it  is  well  to  consider  the  latter  before  going  into 
details  of  the  arrangements  for  ventilation. 

In  the  military  service  the  methods  for  heating  are  practically  con- 
fined to  stoves  and  furnaces  in  the  older  buildings,  hot  water  in  the 
new  hospitals,  and  steam  in  the  new  barracks. 

Stoves  are  of  very  little  value  in  assisting  ventilation  unless  special 
arrangements  are  made  with  that 
end  in  view.  This  may  be  done 
by  partially  surrounding  the  stove 
from  the  floor  to  the  level  of  the 
top  of  the  stove  by  a  sheet-iron 
jacket,  and  admitting  fresh  air 
under  the  stove  from  an  air- 
shaft;  if  in  addition  to  this  the 
stove  pipe  is  made  to  heat  an  ex- 
tracting shaft,  opening  preferably 
at  the  floor  level,  ventilation  may 
be  very  materially  assisted  (Fig. 
225).  Heating  stoves  in  use 
should  always  have  a  pan  of 
water  on  them  to  maintain  the 
proper  maisture  of  the  air. 

Furnaces  are  very  valuable 
ventilators;  fresh  air  is  brought 
to  the  dome  of  the  furnace  by  an 
air  shaft,  heated,  and  delivered, 
where  required,  through  tin  tubes. 

In  hot-water  heating  there  are 
two  systems,  low  pressure  and  high  pressure.    In  the  low-pressure 
system,  which  is  that  used  in  the  army  hospitals,  a  small,  open  tank 


Fig.  226. —  Heating  by  Hot  Water. 
Low    pressure. 


AIR  AND  VENTILATION 


347 


is  provided  at  the  highest  point  of  the  system  to  allow  for  expansion 
and  the  escape  of  gases.  The  circulation  of  the  water  is  due  to  the 
difference  in  weight  of  the  columns  of  hot  and  cold  water.  The 
water  is  heated  in  a  boiler  in  the  hasement;  from  the  top  of  the 
boiler  rises  a  main^  with  branches  to  all  parts  of  the  building;  these 
branches  terminate  in  radiators,  and  from  the  bottom  of  each  radi- 
ator a  branch  return  comes  off,  the  branch  returns  uniting  to  form  a 
main  return,  which  empties  into  the  lower  part  of  the  boiler.  As 
the  water  in  the  boiler  becomes  heated  it  grows  lighter,  and  the 


Fig.  227. —  Heating  by  Steam.     Low  pressure. 


heavier  water  in  the  returns  falls  and  forces  up  the  hot  water,  thus 
effecting  a  circulation  (Fig.  226). 

In  the  high-pressure  system  the  pipes  are  completely  closed ;  hence 
there  is  some  danger  of  explosion,  but  the  water  can  be  made  hotter 
and  circulation  is  more  rapid. 

Steam  heating  is  the  same  in  principle  as  the  low-pressure  hot- 
water  heating,  only  steam  is  used  instead  of  water,  and  the  pipes 
constitute  a  closed  system  (Fig.  22y). 

Radiators  heated  by  either  steam  or  hot  water  may  be  placed  in  the 
room  to  be  heated  without  any  connection  with  the  outside  air ;  this  is 
known  as  the  direct  system;  or  they  may  be  placed  in  the  basement 
or  some  other  room,  enclosed  in  a  sheet-iron  box  connected  with  a 
fresh-air  shaft,  the  warm  air  being  then  conducted  to  the  room,  the 
indirect  system;  or  the  radiator  may  be  placed  in  the  room  to  be 
heated  and  the  fresh  air  brought  directly  in  under  and  allowed  to 
pass  up  between  the  pipes  so  as  to  be  warmed,  the  direct-indirect 
system;  the  last  is  that  commonly  used  in  hospitals  and  barracks 
(Fig.  228). 


348       HYGIENE.     POST  AND  CAMP  SANITATION 

When  no  special  arrangements  have  been  made  for  ventilation  a 
useful  and  simple  device  is  to  place  a  strip  of  board  under  the  lower 
sash,  so  that  air  can  enter  between  the  sashes  and  be  directed  upward 


Fig.  228. —  Heating  by  Direct-Indirect  Method, 


(Fig.  80) ;  or  to  pull  down  the  upper  sash  and  place  a  board  sloping 
down  over  the  opening  left  above  (Fig.  81)  ;  air  will  enter  between 
the  sashes  and  escape  above. 

The  best  simple  test  of  the  efficiency  of  ventilation  is  to  notice  the 
odor  on  coming  into  the  room  from  the  outside  air ;  if  it  is  stuffy 
and  close,  ventilation  is  imperfect. 


CHAPTER   III 

THE   DISPOSAL   OF   WASTES 

The  organic,  dangerous  wastes  which  it  is  necessary  to  dispose  of 
in  such  a  manner  as  not  to  invite  disease  are  night-soil  (urine  and 
feces),  slops  and  garbage;  the  first  is  by  far  the  most  dangerous, 
containing,  as  it  often  does,  the  bacteria  of  disease.  The  arrange- 
ments for  the  reception  of  the  night-soil  may  be  pits,  pans,  or  water- 
closets. 

Pits  are  the  most  objectionable  because  they  pollute  the  soil,  may 
infect  the  water  supply,  and  permit  the  access  of  flies,  which  may 
carry  disease  germs  on  their  feet  and  bodies  from  the  pits  to  the 
kitchens  and  barracks  and  there  infect  the  food  and  drink. 

Pans,  usually  used  in  connection  with  dry  earth  to  cover  and  deo- 
dorize the  feces,  are  little  better  than  pits.  They  are  open  to  the 
same  objections,  except  that  soil  pollution  from  accidental  spilling  is 
not  so  marked;  in  addition  they  have  to  be  emptied,  thus  affording 
another  opportunity  for  scattering  infection  and  creating  a  nuisance. 

Water-closets  are  best.  They  may  discharge  into  cess-pools,  or 
into  sewers.  Cess-pools  are  excavations  in  the  ground  which  may 
or  may  not  have  a  waterproof  lining;  if  they  do  not  have  such  a 
lining  they  are  known  as  leaching  cess-pools.  Cess-pools  are  objec- 
tionable for  the  same  reason  as  pits  and  pans. 

Sewers  are  the  pipes  or  channels  which  carry  off  the  liquid  wastes ; 
the  wastes  themselves  are  known  as  sewage. 

Waster-closets  and  all  plumbing  fixtures  in  dwellings  empty 
through  short  branches  into  a  vertical  iron  pipe  known  as  the  soil 
pipe,  and  this  in  the  basement  empties  into  a  more  or  less  horizontal 
iron  pipe  called  the  house  drain,  and  finally  the  house  drain  beyond 
the  walls  of  the  house  terminates  in  the  sezver.  The  arrangement 
of  the  house  drainage  system  is  well  shown  in  Fig.  229. 

Traps  are  used  on  all  fixtures,  and  these  traps  are  usually  vented 
to  prevent  siphonage.  The  purpose  of  the  traps  is  to  supply  a  water 
seal  to  prevent  seweB  gas  from  getting  into  the  dwelling ;  the  three- 
quarter  S-trap  is  the  type  (Fig.  230).  The  flask  trap  used  by  the 
Quartermaster's  Department  for  lavatories  and  sinks  is  practically 
the  same  as  an  S-trap  in  its  interior  arrangement.     In  yards  and 

(349) 


350       HYGIENE.    POST  AND  CAMP  SANITATION 

basements  where  the  flow  of  water  is  intermittent  a  particular  type 
of  trap  known  as  the  bell  trap  is  generally  employed  (Fig.  231)  ;  the 
objection  to  this  trap  is  that  in  order  to  be  efficient  both  the  cover 
and  the  water  seal  must  be  in  place,  while  as  a  matter  of  fact  the 
one  is  often  misplaced  and  the  other  soon  lost  by  evaporation.  A 
much  better  type  of  trap  is  shown  in  Fig.  232. 


Fig.  229. —  House  Drainage.  A,  B,  C,  Plumbing  fixtures;  D,  disconnecting  trap;  E, 
branch  sewer;  F,  ventilation  opening;  G,  house  drain;  K,  H,  vent  pipes  connected  by 
dotted  lines  with  each  trap. 


Sewage  is  disposed  of  by  discharging  Into  cess-pools,  into  run- 
ning streams,  upon  sewage  farms,  and  by  the  bacterial  purification 
methods. 

The  purpose  of  the  bacterial  purification  systems,  which  are  now 
being  used  in  the  army  to  a  considerable  extent,  is  to  liquefy  and 
purify  the  sewage  so  that  it  may  not  unduly  pollute  the  streams  into 
which  it  is  discharged.  They  consist  essentially  of  two  parts,  a 
closed  tank  in  which  the  bacteria  which  work  in  the  absence  of  air 
liquify  the  organic  solid  matters,  and  a  series  of  filter  beds  in  which 
the  nitrifying  or  air-using  bacteria  continue  the  purification  until 
the  sewage  should  emerge  as  a  clear,  colorless  liquid  like  water. 

Garbage  is  best  disposed  of  by  burning  in  a  crematory  which  is 
usually  in  operation  in  all  the  larger  posts. 

In  the  field  the  disposal  of  wastes,  especially  excreta,  becomes  a 
matter  of  greatest  importance  and  considerable  difficulty. 

Abundant  experience  has  proven  that  whenever  large  bodies  of 
soldiers  are  collected  together  typhoid  fever  is  sure  to  be  introduced 


THE  DISPOSAL  OF  WASTES 


351 


by  some  one,  and  that,  unless  the  command  is  vaccinated  and  proper 
disposal  made  of  excreta,  the  disease  will  spread  through  the  agency 
of  infected  water,  food,  bedding,  clothing,  soil,  dust,  or  flies. 
A  C  B  D 

^^  ^  VI  IT* 

Fig.  230. — Different  Forms  of  Traps.     A,  Running  trap;  B,  S-trap;  C,  i  S-trap;  D,  i  S-trap. 

Latrines  for  the  men  are  always  located  on  the  opposite  side  of 
the  camp  from  the  kitchens,  generally  one  for  each  company  unit 

and  one  for  the  officers  of  a  battalion  or 
squadron.  They  are  so  placed  that  the 
drainage  or  overflow  can  not  pollute  the 
water  supply  or  camp  grounds. 

When  the  camp  is  for  one  night  only, 
straddle  trenches  suffice.     In  camps  of 
Fig.  231.— Bell  Trap.  longer  duration,  and  when  it  is  not  pos- 

sible to  provide  latrine  boxes,  as  for  permanent  camps,  deeper 
trenches  should  be  dug.  These  may  be  used  as  straddle  trenches 
or  a  seat  improvised.  When  open  trenches  are  used  the  excrement 
must  be  kept  covered  at  all  times  with  a  layer  of  earth.  In  more 
permanent  camps  the  trenches  are. not  over  2  feet  wide,  6  feet  deep, 
and  12  feet  long,  and  suitably  screened.  Seats  with  lids  are  pro- 
vided and  covered  to  the  ground  to  keep  flies  from  reaching  the 
deposits;  urinal  troughs  discharging 
into  the  trenches  are  provided.  Each 
day  the  latrine  boxes  are  thoroughly 
cleaned,  outside  by  scrubbing  and  in- 
side by  applying  when  necessary  a  coat 
of  oil  or  whitewash.  The  pit  is  burned 
out  daily  with  approximately  one  gal- 
lon oil  and  fifteen  pounds  straw. 
When  filled  to  within  two  feet  of  the 
surface,  such  latrines  are  discarded, 
filled  with  earth,  and  their  position 
marked.  All  latrines  and  kitchen  pits 
are  filled  in  before  the  march  is  re- 
sumed. In  permanent  camps  and  can- 
tonments, urine  tubs  may  be  placed  in  the  company  streets  at  night 
and  emptied  after  reveille. 


Fig.   232. —  Improved  Yard  Trap. 


352       HYGIENE.     POST  AND  CAMP  SANITATION 

The  proper  disposal  of  garbage  and  stable  refuse  in  camps  is  also 
a  matter  of  importance,  otherwise  they  pollute  the  soil  and  become  a 
breeding  place  for  swarms  of  flies;  everything  which  is  combustible 
must  be  burned ;  what  can  not  be  burned  must  be  buried. 

The  burning  may  be  done  in  the  kitchen  fire,  or  the  solid  garbage 
may  be  mixed  with  more  combustible  matter  such  as  straw  or 
manure,  saturated  with  petroleum  and  burned.  Manure  should  be 
burned  in  the  same  way  as  far  as  practicable. 

In  more  permanent  camps  crematories  should  be  provided.  The 
following  crematory  has  proven  very  effective  in  practice. 


Air  CuaoeNT  •»»»*.  I  ^^rr^T^   \  «*««  Aip Curbent 


Fig.  233. —  Crematory — Vertical  Section.     A  A,  Ground  level. 

At  some  convenient  spot  at  the  rear  of  the  camp,  a  circular  pit 
is  dug  three  feet  deep  and  fifteen  feet  in  diameter.  The  bottorh  is 
covered  with  loose  stones  to  the  depth  of  fourteen  to  sixteen  inches. 
On  this  is  built  a  circumferential  wall  to  the  height  of  one  foot 
above  the  original  ground  level,  and  the  excavated  earth  is  packed 
against  it,  clear  to  the  top  so  as  to  provide  a  sloping  approach  and 
thereby  prevent  surface  water  gaining  access  to  the  pit.  A  pyra- 
mid of  large  stones,  four  or  five  feet  high,  occupies  the  center.  This 
feature  is  essential  to  provide  central  draft  and  steady  fire. 

The  bottom  stones  receive  the  liquid  portions  of  the  garbage 
without  affecting  the  fire,  and  the  heated  stones  soon  evaporate  and 
dissipate  it.  The  solid  portions  are  soon  desiccated  and  become 
fuel.  Care  should  be  exercised  to  empty  the  garbage  into  and  not 
around  the  crematory. 

The  following  rules  for  the  sanitation  of  camps  sum  up  the  whole 
subject : 

(a)  When  practicable,  camps  should  be  established  on  high  and 
well-drained  ground  not  previously  occupied, 

(&)  Men  should  not  lie  on  damp  ground.  In  temporary  camps 
and  in  bivouac  they  raise  their  beds  if  suitable  material,  such  as 
straw,  leaves,  or  boughs,  can  be  obtained,  or  use  their  ponchos  or 
slickers.    In  cold  weather  and  when  fuel  is  plentiful  the  ground  may 


THE  DISPOSAL  OF  WASTES  353 

be  warmed  by  fires,  the  men  making  their  beds  after  raking  away 
the  ashes. 

(c)  Tent  walls  are  raised  and  the  bedding  and  clothing  aired 
daily,  weather  permitting. 

(d\  In  camps  of  permanence  excreta  should  be  disposed  of  by 
sewers  or  incinerators. 

(e)  All  kitchen  refuse  should  be  promptly  burned  or  buried,  and 
perfect  sanitary  police  maintained. 

(/)  The  water  supply  is  carefully  guarded.  When  several  com- 
mands are  encamped  along  the  same  stream  this  matter  is  regulated 
by  the  senior  officer. 

If  the  stream  is  small,  the  water  supply  may  be  increased  by 
building  dams.  Small  springs  may  be  dug  out  and  lined  with  stone, 
brick,  or  empty  barrels.  Surface  drainage  is  kept  off  by  a  curb  of 
clay. 

When  sterilized  water  is  not  provided,  or  when  there  is  doubt  as 
to  the  purity  of  the  water,  it  is  boiled  twenty  minutes,  then  cooled 
and  aerated. 

(g)  The  discharges  of  patients  with  typhoid  fever,  camp  diar- 
rhea, or  cholera  should  always  be  disinfected  at  once  with  a  solution 
of  phenol  (5  per  cent)  or  of  chloride  of  lime  (six  ounces  to  the 
gallon  of  water),  or  with  milk  of  lime,  made  from  fresh  quick-lime. 

(h)  The  diseases  just  mentioned  are  frequently  communicated  to 
soldiers  in  camp  through  the  agency  of  flies,  which  swarm  about 
fecal  matter  and  filth  of  all  kinds,  and  directly  convey  infectious 
material,  attached  to  their  feet  or  contained  in  their  excreta,  to  the 
food  which  is  exposed  while  being  prepared  at  the  company  kitchen 
or  while  being  served  in  the  mess  tent.  The  water  supply  may  be 
contaminated  in  the  same  way,  or  by  surface  drainage.  Infection 
is  also  often  carried  on  the  hands  and  shoes.  It  is  for  these  rea- 
sons soldiers  are  required  to  wash  their  hands  before  meals  and  after 
visiting  the  latrines,  and  that  all  kitchens  and  mess  shelters  should 
be  screened  to  exclude  flies. 

(i)  If  it  can  be  avoided,  marches  should  not  be  made  in  the 
hottest  part  of  the  day. 

(/)  When  called  upon  for  duty  at  night  or  early  in  the  morning 
a  cup  of  hot  coffee  should  be  taken. 

(k)  It  is  unsafe  to  eat  heartily  or  drink  freely  when  greatly 
fatigued  or  overheated.  If  alcoholic  drinks  are  used  at  all,  such  use 
23 


354       HYGIENE.     POST  AND  CAMP  SANITATION 

should  be  postponed  until  after  the  day's  march  and  preferable  in 
conjunction  with  the  evening  meal. 

(/)  Ripe  fruit  may  be  eaten  in  moderation,  but  green  or  over-ripe 
fruit  will  give  rise  to  bowel  complaints.  Food  should  be  thoroughly 
cooked  and  free  from  fermentation  or  putrefactive  changes. 

(w)  In  decidedly  malarious  localities  from  three  to  five  grains  of 
quinine  should  be  taken  three  times  a  day  as  a  prophylactic,  but  the 
taking  of  quinine  as  a  routine  practice  should  only  be  recommended 
under  exceptional  circumstances. 

The  best  safeguard  against  malaria  is,  however,  the  protection  of 
the  body  against  the  bites  of  infected  mosquitoes.  To  this  end  mos- 
quito nets  should  be  used  whenever  available  in  malarial  localities 
or  seasons,  and  if  not  available  the  skin  should  be  as  far  as  possible 
covered  during  sleep. 

(m)  Light  woolen  underclothing  should  be  worn,  and  when  a 
soldier's  clothing  or  bedding  becomes  damp  from  exposure  to  rain 
or  heavy  dews  the  first  opportunity  should  be  taken  to  dry  it  in  the 
sun  or  by  fires. 


CHAPTER    IV 

DISEASE    PREVENTION 

In  chapter  XIII  of  the  section  on  "  Nursing"  the  infectious  dis- 
eases have  already  been  discussed  as  far  as  the  prevention  of  their 
spread  in  posts  is  concerned. 

While  there  are  no  diseases  entirely  peculiar  to  camp  life,  there 
are  certain  diseases  which  are  specially  apt  to  become  epidemic 
under  the  more  crowded  conditions  which  necessarily  prevail  in 
camps. 

Among  the  more  notable  of  these  diseases  are  typhoid  fever  and 
malarial  fevers,  diarrhea  and  dysentery,  the  eruptive  fevers, 
bronchial  troubles  and  rheumatism,  and  in  certain  climates  yellow 
fever  and  cholera. 

Typhoid  fever.  To  prevent  typhoid  fever  in  the  field  all  soldiers 
should  be  vaccinated  with  the  typhoid  prophylactic;  in  addition  all 
urine  and  feces  must  be  disinfected ;  soil  pollution  must  be  prevented ; 
flies  must  be  destroyed ;  drinking  water  must  be  boiled ;  men  must 
not  be  allowed  to  bathe  in  polluted  water  lest  they  get  it  into  their 
mouths;  in  permanent  camps  the  kitchens  and  messes  must  be 
screened  against  flies  and  all  food  protected  from  both  flies  and  dust. 

Flies  breed  in  decayed  organic  matter,  especially  in  stable  manure, 
which  should,  therefore,  never  be  allowed  to  accumulate  in  camp  or 
garrison.  In  their  reproduction  flies  pass  through  the  stages  of 
ovum  or  e%g,  larva  or  maggot,  pupa,  and  adult.  They  carry  not 
only  typhoid  fever  but  also  cholera,  tuberculosis,  and  probably  other 
diseases.  Besides  the  common  fly  which  carries  these  diseases  on  its 
feet  and  body  there  is  a  biting  fly,  known  as  tsetse,  which  transmits 
sleeping  sickness  and  other  trypanosome  diseases,  by  biting,  in  the 
same  manner  as  a  mosquito  transmits  malaria. 

Malarial  fevers.  We  have  seen  that  malaria  is  spread  in  one  way 
only,  that  is  by  the  bites  of  the  anophelince  mosquitoes  which  have 
previously  bitten  a  human  being  who  has  malaria.  As  protection 
against  malaria  involves  mosquito  destruction,  it  is  necessary  to 
learn  something  about  the  life  history  of  mosquitoes. 

(355) 


356       HYGIENE.     POST  AND  CAMP  SANITATION 


Though  all  mosquitoes  are  annoying,  only  three  kinds,  as  far 
as  we  know,  carry  disease;  these  are  the  anophelince,  which  carry 
malaria ;  culex  fatigans,  which  carries  dengue  and  in  certain  localities 
in  the  tropics  a  blood  worm  (filaria)  which  causes  elephantiasis; 
and  (vdes  calopiis,  which  carries  yellow  fever. 

It  is  the  female  mosquito  only  that  bites,  and  therefore  the  female 
only  which  conveys  disease,  ^des  calopus  (the  yellow-fever 
mosquito)  is  especially  a  day  biter,  and  where  mosquitoes  are  found 
biting  in  the  daytime  they  are  apt  to  be  of  that  variety.  Then  again 
cedes  calopus  is  the  blackest  mosquito,  and  is  beautifully  marked  with 
silver  bands  on  the  legs  and  body ;  a  lyre-shaped  silver  mark  on  the 

back  is  characteristic  and 
identifies  cedes  calopus  at 
once.  This  mosquito  is  of 
medium  size  (Figs.  234,  235). 
The  anophelince  (the  ma- 
larial mosquito),  Fig.  236, 
differ  from  culex  and  ste- 
gomyia  in  having  palpi  as  long 
as  the  proboscis  in  the  female : 
this  mosquito  differs  also  from 
the  other  two  in  that  the  body 
and  proboscis  of  the  anoph- 
elince form  one  straight  line, 
while  the  other  mosquitoes 
are  humpbacked.  The  resting 
position  of  the  anophelince  is 
nearly  vertical  to  the  surface, 
while  that  of  cedes  calopus 
and  culex  approaches  the  hori- 
zontal (Fig.  22,y). 
The  males  of  all  mosquitoes  are  distinguished  from  the  females 
by  the  fact  that  the  former  have  feathered  antennae  (woolly  heads), 
while  the  latter  have  not  (Fig.  247). 

The  yellow-fever  mosquito  is  essentially  a  domestic  or  house 
mosquito ;  that  is  to  say,  she  breeds  in  small  collections  of  water  such 
as  are  found  about  a  house,  and  does  not  stray  far  from  home. 
The  malarial  mosquito  is  a  rural  or  country  insect;  breeds  in  large 


Fig.  234. —  Aides  calopus,  male. 


DISEASE  PREVENTION 


357 


pools,  the  still  edges  of  running  streams,  irrigating  ditches,  etc., 
and  is  found  far  from  human  habitations. 

When  one  of  these  mos- 
quitoes bites  a  person  afflicted 
with  the  disease  which  she  is 
capable  of  carrying,  she  sucks 
a  little  blood  and  with  it  the 
germs  of  the  disease.  After 
a  week  or  two  these  germs  re- 
produce themselves  in  the 
mosquito,  migrate  to  her  sali- 
vary glands,  and  she  then  be- 
comes capable  of  infecting 
other  persons.  If  she  now 
bites  such  a  person,  she  in- 
jects into  his  blood  with  her 
saliva  some  of  the  germs,  and 

after  a  variable  period,  known  fig.  235.— ^Edes  caiopus,  female. 

as  the  period  of  incubation,  that  person  is  usually  taken  down  with 
the  disease. 

The  measures  to  be  taken 
to  prevent  such  diseases  are 
destruction  of  mosquitoes, 
protecting  the  mosquitoes 
against  infection  by  screening 
infected  persons  —  and  in  the 
case  of  malaria  destroying  the 
germs  in  their  blood  by  the 
use  of  quinine ;  protecting  well 
persons  from  infection  by  the 
use  of  screens  and  nets,  and  in 
the  case  of  malaria,  by  the  use 
of  quinine  to  render  the  blood 
insusceptible  to  infection. 

Mosquitoes  breed  only  in 
water,  but  very  little  water  is 
required  for  the  purpose.  The  female  deposits  her  eggs  to  the  num- 
ber of  40-400  upon  the  surface  of  the  water,  and  after  a  period  of 


Fig.   236. —  Anopheles  macnlipennis    (quad- 
rimaculatus),  female. 


358       HYGIENE.     POST  AND  CAMP  SANITATION 


twenty- four  hours  to  two  or  three  days  they  hatch,  becoming  larvco  or 
miggle-tails;  the  larval  stage  last  one  or  two  weeks  until  the  pupce 


1  t  3 

Fig.  237. —  Resting  posture  of  mosquitoes:    i  and  2,  Anopheles;    3,  Culex  Pipiens. 


form;    after  two  to  five  days 
imagos  or  adult  insects  emerge 


Fig.  238. —  Culex  pungens,  male. 

we  prevent  mosquito  breeding. 
This  is  accomplished  by  drain- 
ing and  filling,  and  by  remov- 
ing all  small  articles  capable 
of  holding  water.  Collections 
of  water  that  can  not  be  re- 
moved should  be  closely  cov- 
ered and  screened,  or  else 
oiled  with  petroleum,  about  an 
ounce  to  each  fifteen  square 
feet  of  surface,  the  petrolis- 
ing  being  repeated  about  once 
a  week. 


more  the  pupal  shells  split  and  the 

(Figs.  240  to  246). 

The  entire  transition  from 
egg  to  adult  insect  requires 
from  ten  days  to  two  or  three 
weeks. 

Any  collection  of  water, 
provided  it  is  moderately  still, 
answers  the  mosquito  for 
breeding  purposes.  They 
breed  in  marshes,  ponds, 
ditches,  rain  barrels,  cisterns, 
gutters,  watering  troughs, 
hoof-prints,  old  tin  cans,  in 
fact  anything  capable  of  hold- 
ing water.  By  allowing  no 
unprotected  water  collections 


Fig.   239. —  Culex  pungens,  female. 


DISEASE  PREVENTION 


359 


Fic.   240.— A  raft  of  Culex  ova.  Fig.   241.—  Patterns  assumed  by  Ano- 

pheles ova. 


Fig.    242. —  Egg.      Anopheles  raaculipcnnis       Fig.  243. —  Larva  of  Anopheles  mosquito, 
(quadrimaculatus) . 


Fig.   244.— Larva  of  Anopheles  macuH-  Fig.  245- — Larva  of  a  Culex  mosquito, 

pennis   (quadrimaculatus). 


360       HYGIENE.    POST  AND  CAMP  SANITATION 


Adult  mosquitoes  may  be  destroyed  by  fumigating  with  sulphur 
or  pyrethrum  in  the  closed  apartment,  using  about  one  pound  to  the 
thousand  cubic  feet  of  air  space ;  if  pyrethrum  is  used  the  mosqui- 
toes are  only  stupefied  and  must  be  subsequently  swept  up  and 
burned. 

Other  measures  for  destroying  mosquitoes  are  the  clearmg  away 
of  all  vines,  brush,  tall  grass,  and  undergrowth ;  such  conditions  do 
not  breed  mosquitoes,  but  they  give  them  shelter  against  the  winds, 
which  would  otherwise  blow  them  away. 

In  the  tropics  the  natives,  especially  the  children,  often  carry 
malarial  parasites  in  the  blood,  even  though  they  show  no  sign  of 
the    disease,    therefore    camp    should   not    be 
made  in  native  villages  and  natives  should  not 
be  allowed  about  the  barracks. 

In  the  field  it  is  usually  impracticable  for 
soldiers  to  sleep  under  mosquito  nets,  but 
where  malaria  prevails  a  considerable  degree 
of  protection  may  be  secured  by  requiring  each 
soldier  to  wear  gauntlets  and  a  small  head-net 
while  asleep  or  on  guard. 

Yellow  fever  resembles  malarial  fever  in  its 
method  of  spread,  and  in  the  measures  of  pre- 
vention except  that  quinine  has  no  value  in 
prevention  and  is  harmful  in  treatment.  Yel- 
low fever  differs  from  malarial  fever  in  that 
its  course  is  always  acute,  the  fever  seldom 
lasting  longer  than  five  to  seven  days,  and 
especially  in  that  an  attack  affords  almost 
complete  protection  against  a  second,  while 
in  malaria  one  attack  seems  to  predispose  to 
others,  and  the  infection  of  malaria  may  re- 
main in  the  blood  indefinitely. 
Diarrheas  which  are  so  prevalent  among  troops  in  the  field  are 
due  to  a  variety  of  causes.  Infection  of  food  by  flies,  faulty  cook- 
ing, overeating,  improper  food,  particularly  that  purchased  from 
camp  venders,  exposure  to  chilling,  especially  at  night,  and  impure 
water  are  common  causes.  Many  diarrheas  are  probably  merely 
symptomatic  of  graver  disorders  such  as  typhoid  fever  or  dysentery. 
The  proper  preventive  measures  are  the  supply  of  proper  food 


Fig.    246. — ^Pup;e: 
I,  Culex;    2,  Ano- 
pheles; 3,  JEdes  Calopus. 


DISEASE  PREVENTION 


361 


well  cooked  and  protected  from  flies,  the  suppression  of  camp 
venders,  the  furnishing  of  sterihzed  drinking  water,  and  the  general 
use  of  woolen  undershirts  sufficiently  long  to  cover  the  abdomen; 
such  a  shirt  is  much  better  than  an  abdominal  band. 

The  dysenteries  are  of  three  types,  the  catarrhal,  due  to  exposure 
and  improper  food ;  the  hacillary  or  epidemic  form,  and  the  amebic 
or  tropical  form  of  dystentery ;  the  last  two  forms  are  infectious  and 
the  measures  of  prevention  are  the  same  as  in  typhoid  fever. 

The  eruptive  fevers  are  especially  apt  to  occur  and  become  epi- 
demic when  large  numbers  of  young  men  are  brought  into  the  inti- 
mate contact  of  the  camp ;  the 
general  method  of  preventing 
their  spread  has  been  dis- 
cussed, but  it  is  necessary  to 
describe  here  in  detail  the 
special  and  most  important 
preventive  measure  against 
smallpox,  viz.,  vaccination. 

Vaccination  is  the  process 
of  inoculating  a  person  with 
vaccine  virus,  producing  the 
condition  known  as  vaccinia. 

Vaccinia  is  an  eruptive  dis- 
ease  of  the  cow,  the  virus  of 
which  when  inoculated  in 
man  produces  a'  local  pock 
with  constitutional  disturb- 
ance, and  protects  against 
smallpox;  vaccinia  is  proba- 
bly smallpox  of  the  cow,  but 
it  has  not  been  proven  that 
such  is  the  case. 


Fig.   247. —  Heads  of  mosquitoes:     i  and  2, 

male   and    female    Culex    punpens;  3    and 

4,  male  and   female   Anopheles;    s  and  (, 
male  and  female  .i5vdes  Calopus. 


Bovine  vaccine  virus,  that  is,  virus  from  the  calf,  is  now  used  to 
the  exclusion  o.f  hum.an  virus  on  account  of  the  danger  with  the 
latter  of  transmitting  human  diseases. 

Vaccine  is  usually  provided  either  on  bone  points  or  in  capillary 
tubes ;  in  either  case  the  virus  is  preserved  by  glycerin,  but  it  gradu- 
ally loses  its  power  and  becomes  inert ;  it  should  always  be  kept  in 
a  dark,  cool,  dry  place. 


362       HYGIENE.     POST  AND  CAMP  SANITATION 

In  performing  vaccination  it  should  be  borne  in  mind  that  it  is  a 
surgical  operation  and  that  the  same  care  must  be  taken  to  prevent 
infection  as  in  any  other  operation.  The  hands  of  the  operator, 
the  surface  operated  upon,  and  everything  coming  in  contact  with 
either  should  be  as  nearly  sterile  as  possible;  at  the  same  time  it 
must  be  remembered  that  active  antiseptics  will  destroy  the  vaccine. 

"  The  skin  at  selected  site  must  be  clean;  antiseptics  are  not  nec- 
essarily employed;  should  they  be  used  they  must  be  washed  away 
with  sterile  water  that  the  activity  of  the  virus  be  not  destroyed. 
Washing  with  warm  water,  followed  by  alcohol,  is  usually  sufficient, 
the  alcohol  being  permitted  to  evaporate  before  proceeding.  Scrub- 
bing with  soap  and  water  is  necessary  for  a  dirty  skin,  but  needless 
irritation  of  the  skin  is  to  be  avoided. 

"  Incision  is  the  method  of  choice  and  it  should  be  made  with  the 
point  of  a  sterile  needle,  producing  a  '  scratch.'  A  sterile  scalpel  may 
be  used,  but  is  more  likely  to  cause  bleeding.  The  incision  or 
scratch  should  preferably  not  draw  blood.  There  should  be  at  least 
two  incisions,  three-quarters  of  an  inch  long  and  one  inch  apart; 
after  exposure  to  small  pox  four  incisions  will  be  made.  The  virus 
is  then  placed  upon  the  abraded  surface  and  gently  rubbed  in, 
unnecessary  irritation  being  avoided." 

"  The  wound  is  allowed  to  dry  thoroughly  and  can  be  left  without 
dressing,  though  several  layers  of  gauze  may  be  applied  with 
adhesive  plaster.  Any  dressing  that  retains  heat  and  moisture  is 
bad.     Shields  will  not  be  used." 

If  a  vaccination  takes  properly,  about  the  third  to  the  fifth  day 
after  the  operation  a  small  papule  or  pimple  will  be  noticed  at  the 
spot  scarified;  by  the  seventh  day  the  papule  has  become  a  vesicle 
or  blister  depressed  in  the  center;  by  the  eighth  or  ninth  day  the 
vesicle  has  become  full  size  and  an  areola  or  red  blush  appears 
around  it ;  at  the  same  time  the  glands  under  the  arm  become  a  lit- 
tle swollen  and  painful,  and  there  may  be  some  fever  and  general 
discomfort ;  on  the  eleventh  or  twelfth  day  the  redness  and  soreness 
begin  to  disappear,  the  contents  of  the  blister  become  cloudy,  and  it 
begins  to  dry  up,  forming  a  scab  which  drops'  oflf  about  the  twenty- 
fourth  day,  leaving  a  characteristic  pit  or  pits  which  is  the  sign  of  a 
successful  vaccination. 

Vaccination  does  not  always  follow  this  typical  course ;  sometimes 
the  whole  duration  of  the  inflammation  is  much  shorter,  and  the  pit 


DISEASE  PREVENTION  363 

or  pock  is  not  so  marked;  this  is  especially  apt  to  be  the  case  in 
revaccination.  Sometimes,  especially  when  the  operation  has  been 
carelessly  done  or  the  vesicle  is  prematurely  broken,  violent  inflam- 
mation results,  with  sloughing  and  ulceration.  Occasionally  the 
vaccinia  is  generalized,  vesicles  forming  at  other  points  on  the  arm, 
or  even  over  the  entire  body. 

Cholera  (Asiatica)  runs  its  course  very  acutely  in  typical  cases, 
oftentimes  terminating  fatally  in  twenty-four  hours.  It  is  character- 
ized by  violent  vomiting  and  purging  —  the  discharges  soon  becom- 
ing like  water  —  by  great  prostration  and  muscular  cramps.  It 
must  not  be  forgotten,  however,  that  the  only  symptom  may  be  an 
ordinary  diarrhea,  and  that  such  cases  are  just  as  infectious  as  the 
severe  type.     The  preventive  measures  are  described  on  page  254. 


CHAPTER  V 

SANITATION    IN    THE  FIELD 

The  selection  of  a  camp  site  will  often  depend  upon  military  con- 
siderations; the  essential  requirements  are  wood,  water,  and  grass, 
and  from  a  sanitary  standpoint  dryness,  elevation,  and  some  pro- 
tection from  winds. 

An  old  camp  site  should  never  be  occupied  because  the  soil  is  cer- 
tain to  be  polluted  and  probably  infected  ;  outbreaks  of  typhoid  fever 
and  cholera  have  repeatedly  followed  the  occupation  of  old  sites. 

Sites  covered  with  rank  vegetation  should  be  avoided,  as  such 
vegetation  indicates  excessive  moisture.  Open  woods  are  not  un- 
favorable camp  grounds,  as  they  afford  some  protection  from  sun 
in  summer  and  winds  in  winter,  but  dense  woods  should  never  be 
occupied  on  account  of  the  dampness,  stagnation  of  air,  and  decay- 
ing vegetation.  All  underbrush  should  be  removed  from  camp,  but 
sod  should  not  be  disturbed. 

Tents,  as  soon  as  pitched,  must  be  trenched;  if  the  tent  site  is 
covered  with  grass  the  grass  should  be  cut  or  pulled  up,  because  it 
will  die  anyway  and  its  decomposition  will  help  to  pollute  the  air; 
the  soil  should  be  well  pounded  and  covered,  if  practicable,  with  a 
layer  of  ashes  or  gravel,  also  well  pounded.  In  permanent  camps 
the  tents  should  be  floored,  but  the  floors  should  be  in  sections  of 
such  size  that  they  can  be  readily  removed  for  policing  and  sunning 
the  ground  underneath.  No  eatables  should  ever  be  allowed  in  tents 
other  than  the  kitchen  and  mess.  The  interval  between  tents  in  the 
same  row  should  be  at  least  equal  to  the  height  of  the  ridge. 

All  tents  are  crowded,  not  more  than  about  eighty  cubic  feet  of  air 
space  being  usually  allowed ;  therefore  the  greatest  attention  should 
be  paid  to  ventilation ;  dry  canvas  allows  some  penetration  of  air, 
but  moist  canvas  is  practically  impervious.  Tent  walls  should  always 
be  kept  looped  up  in  summer  and  even  in  winter  whenever  possible. 
Every  three  or  four  days  the  tents  should  be  removed  to  the  adjoin- 
ing area  and  turned  inside  out,  so  that  the  interior  may  be  sunned 
at  the  sam^  time  as  the  tent  floor.     About  once  in  ten  days  the  entire 

(364) 


SANITATION  IN  THE  FIELD  365 

camp  should  be  removed  to  at  least  a  sufficient  distance  to  entirely 
clear  the  old  site. 

As  the  ground  is  always  more  or  less  damp  and  removes  the  heat 
of  the  body  rapidly,  a  soldier  should  never  sleep  directly  upon  it  if 
it  can  be  avoided;  if  nothing  else  is  available,  his  poncho  should  be 
placed  under  him,  but  if  possible  he  should  raise  himself  above  the 
ground  by  the  use  of  hay,  straw,  evergreen  boughs,  or  improvised 
bunk.  Bedding  should  be  removed  and  aired  daily,  being  hung  upon 
lines  if  practicable. 

The  police  of  the  camp  within  and  without  the  tents  should  be 
thorough.  The  disposal  of  garbage  has  already  been  described; 
at  night  men  who  wish  to  urinate  will  often  do  so  just  outside  the 
tent  rather  than  go  to  the  distant  sink ;  therefore  urine  tubs  contain- 
ing a  disinfectant  solution  should  be  placed  in  the  company  streets 
every  night,  and  removed  in  the  morning;  their  position  should  be 
indicated  by  a  lantern;  the  position  of  the  sinks  should  also  be 
indicated  by  a  lantern  on  dark  nights. 

The  water  supply  of  the  camp  is  of  the  greatest  importance ;  as  a 
general  rule  all  water  supplies  of  inhabited  regions  in  the  tropics 
must  be  regarded  as  infected  and  require  boiling  before  use;  the 
same  may  be  said  of  surface  waters,  and  shallow  wells  in  other 
climates. 

As  soon  as  a  camp  is  occupied  a  guard  is  placed  over  the  water 
and  proper  places  designated  for  bathing,  washing  of  clothing, 
watering  animals,  etc. 

Among  the  minor  but  still  important  troubles  incident  to  field 
service  are  foot-soreness,  chafing,  and  occasionally  body  lice. 

To  avoid  foot-soreness  the  first  requisite  is  a  properly  shaped  and 
fitted  shoe;  the  next  is  clean  feet  and  clean,  dry  socks.  No  other 
shoe  than  that  supplied  by  the  Quartermaster's  Department  should 
ever  be  worn.  The  feet  should  be  carefully  washed  at  the  end  of 
the  march,  thoroughly  dried,  and  the  socks  changed,  the  used  pair 
being  washed  or  at  least  sunned  and  dried  for  the  next  day.  Toe- 
nails should  be  cut  square  across  and  not  too  short;  if  there  is  a 
tendency  to  soreness,  anointing  the  feet,  especially  between  the  toes, 
with  vaseline,  is  effective;  in  the  absence  of  vaseline,  foot  powder 
may  be  dusted  on  the  feet  and  into  the  socks;  vaseline  is  better 
than  powders.  If  there  are  blisters  they  should  not  be  opened  unless 
they  are  so  large  that  they  would  break  in  walking;  cover  each  with 


366       HYGIENE.     POST  AND  CAMP  SANITATION 

a  small  piece  of  adhesive  plaster;  if  the  blister  must  be  opened  make 
the  smallest  opening  possible  with  a  needle  or  pin  and  gently  press 
out  the  fluid.  If  the  skin  is  rubbed  off  cover  with  plaster.  Hard 
corns  should  be  trimmed  close  or  scraped  with  a  piece  of  glass ;  soft 
corns  require  treatment  by  a  medical  officer. 

Chafing  is  especially  apt  to  occur  in  the  crotch  or  other  joint 
flexures;  the  best  preventive  of  chafing  and  body  vermin  is  cleanli- 
ness. Take  a  bath  daily,  but  if  water  is  scarce  at  least  wash  the 
feet,  hands,  arm-pits,  and  genitals.  Should  chafing  occur  use 
vaseline  or  foot  powder. 

When  lice  are  found  on  the  body  cut  the  hair  of  the  parts  close 
and  apply  blue  ointment,  or  solution  of  corrosive  sublimate  i  :5oo. 
The  underclothes  must  be  boiled,  or  washed  in  sea  water. 


CHAPTER  VI 

PERSONAL  HYGIENE 

This  subject  has  been  dealt  with  generally  under  other  headings, 
but  it  is  necessary  to  cover  a  few  points  here  which  have  not  been 
included  elsewhere. 

The  first  requisite  for  good  health  is  cleanliness  of  person  and 
clothing;  the  former  is  not  usually  difficult  to  obtain,  but  the  latter 
often  presents  serious  obstacles  in  the  field.  Every  opportunity 
should  be  taken  to  wash  the  underclothing;  if  very  dirty  it  should 
be  soaked  for  awhile  before  scrubbing;  woolen  articles  should  be 
rinsed  and  scrubbed  as  little  as  possible,  as  such  treatment  renders 
them  hard  and  causes  shrinking.  When  water  is  not  available  the 
underclothing  should  be  changed,  dried  in  the  sun,  aired,  and  beaten. 

In  the  tropics  a  contagious  skin  disease  known  as  dhohie  itch  is  of 
frequent  occurrence ;  it  is  usually  due  to  uncleanliness  and  infected 
underwear.  Besides  treatment  of  the  disease  it  is  necessary  to  boil 
the  underwear  to  get  rid  of  the  infection. 

Particular  attention  should  be  paid  to  the  teeth,  a  tooth  brush 
being  used  twice  a  day;  ulceration  of  the  gums,  so  prevalent  in  the. 
tropics,  may  be  thus  avoided,  but  if  it  occurs  the  soldier  should  report 
to  his  medical  officer  for  treatment. 

The  hair  should  be  kept  short  and  frequently  washed. 

The  purpose  of  clothing  is  to  protect  the  body  from  the  vicissi- 
tudes of  weather;  from  heat  in  summer,  cold  in  winter,  and  from 
the  chilling  effects  of  rain  and  wind. 

The  fulfillment  of  these  purposes  depends  upon  the  nature  of  the- 
material,  its  texture,  color,  its  heat-conducting  and  water-absorbing 
properties. 

The  materials  of  which  clothing  is  made  are  wool,  cotton,  and 
linen. 

Wool  is  a  poor  conductor  of  heat  and  a  good  absorber  of  mois- 
ture ;  hence  it  keeps  in  the  heat  of  the  body  in  winter  and  keeps  out 
the  heat  of  the  sun  in  summer;  by  its  property  of  absorbing  and 
condensing  moisture,  thus  setting  free  its  latent  heat,  it  prevents 

(367) 


368       HYGIENE.    POST  AND  CAMP  SANITATION 

chilling  of  the  body  when  perspiring  after  exertion ;  these  properties 
render  it  suitable  for  undergarments  in  both  summer  and  winter, 
and  for  outer  garments  in  winter. 

Cotton  and  linen  are  good  conductors  and  poor  absorbers  of 
moisture,  qualities  which  adapt  them  for  use  in  outer  garments  in 
hot  weather. 

The  color  of  outer  garments  has  no  influence  on  the  temperature 
of  the  body  except  in  the  direct  rays  of  the  sun ;  black  and  dark 
colors  absorb  the  direct  sun's  rays  the  most,  while  white  and  yellow 
reflect  them  most. 

Besides  color  and  material,  texture  has  an  important  influence  on 
the  power  of  conducting  heat;  the  more  loosely  woven  a  material  is 
the  more  air  there  is  in  the  texture,  and  as  air  is  a  very  poor  con- 
ductor, the  warmer  the  material.  Hence,  the  warmth  of  fur  and 
feathers.  Impervious  stuff,  such  as  rubber  and  to  a  less  degree 
leather,  keep  out  winds  and  are  warm  for  that  reason. 

Venereal  diseases  constitute  one  of  the  greatest  dangers  to  which 
the  soldier  is  exposed;  their  hospital  management  is  discussed  on 
page  255  ;  but  it  is  necessary  to  look  at  them  from  the  point  of  view 
of  personal  hygiene.  Ordinarily  regarded  by  the  soldiers  as  matters 
of  trivial  importance,  gonorrhea,  chancroid,  and  syphilis  are  so  far- 
reaching  in  their  effects  that  these  effects  should  be  thoroughly 
understood. 

Gonorrhea  or  clap,  besides  the  immediate  discomfort  and  incon- 
venience caused  by  it,  is  often  followed  by  swollen  testicle,  stricture 
of  the  urethra,  and  stricture  of  the  spermatic  ducts  so  that  the 
semen  cannot  escape,  and  the  man  becomes  sterile ;  by  a  very  severe 
form  of  rheumatism,  inflammation  of  the  bladder  and  kidneys,  and 
occasionally  septicemia  and  death.  Getting  a  little  of  the  gonor- 
rheal pus  into  the  eye  from  unclean  fingers  or  towels  produces  a 
destructive  inflammation  often  resulting  in  blindness. 

In  syphilis  the  blood  is  infected,  and  while  the  disease  is  curable 
one  can  never  be  certain  that  the  cure  is  permanent. 

The  first  stage  is  the  chancre,  the  second  the  skin  eruptions  and 
the  mucous  patches,  while  in  the  third  we  have  the  terrible  de- 
structive affections  of  the  bones,  internal  organs,  nervous  system, 
and  blood-vessels.  Sometimes  the  nose  is  eaten  away  or  caves  in, 
the  palate  is  destroyed,  the  voice  lost,  and  paralysis,  locomotor 
ataxia,  and  aneurism  are  among  the  later  results.     Add  to  this  that 


PERSONAL  HYGIENE  369 

if  the  syphilitic  marries  he  is  liable  to  infect  his  wife  and  very  apt 
to  beget  syphilitic  children,  and  the  gravity  of  the  disease  may  be 
seen. 

The  probability  of  contracting  some  form  of  venereal  disease  in 
illicit  intercourse  is  very  great;  about  a  third  of  all  women  pros- 
titutes are  infected ;  all  are  certain  to  become  so  in  course  of  time. 

The  only  certain  protection  against  venereal  disease  is  absolute 
avoidance  of  impure  intercourse.  This  involves  continence  in  the 
unmarried  soldier.  There  is  a  widespread  impression  that  con- 
tinence is  harmful  to  the  young  and  vigorous  man;  nothing  is 
further  from  the  truth.  Nature  has  provided  emissions  for  the 
discharge  of  an  undue  accumulation  of  seminal  fluid,  and  their 
occasional  occurrence  does  no  harm. 

As  Alcoholism  leads  to  sexual  indulgence  the  two  conditions  should 
be  considered  together.  The  healthy  man  does  not  require  alcohol 
in  any  form ;  though  it  is  occasionally  taken  habitually  for  long 
periods  without  any  apparent  bad  results,  there  is  no  doubt  that 
even  in  such  cases  there  is  diminished  resistance  to  disease.  Though 
the  temporary  effect  of  alcohol  is  stimulating,  this  effect  is  promptly 
followed  by  diminished  resisting  power  to  both  heat  and  cold. 

The  weight  of  evidence  is  that  alcohol  is  particularly  harmful  in 
the  tropics,  and  many  of  the  cheap  native  forms  of  crudely  distilled 
liquors  which  are  obtainable  there  have  specially  poisonous  effects. 

To  guard  against  the  special  diseases  of  the  tropics  one  of  the 
most  important  general  rules  is  to  strictly  avoid  all  native  prepared 
foods  and  drinks ;  the  method  of  their  preparation  is  usually  filthy 
in  the  extreme,  and  they  are  frequently  infected  with  the  germs 
of  disease. 

Native  fruits,  in  good  condition,  neither  unripe  nor  over-ripe, 
may  be  taken  in  moderation,  but  the  outerskin  should  always  be 
removed,  or  thoroughly  washed  in  pure  water. 

The  sun,  in  the  heat  of  the  day,  should  be  avoided  when  possible, 
and  when  in  the  sun  the  back  of  the  head  and  neck  should  be  pro- 
tected by  a  handkerchief  or  piece  of  muslin  attached  to  the  back 
of  the  cap  or  hat.  The  Japanese  soldiers  use  such  a  flap  in  two 
pieces  so  as  to  allow  free  passage  of  air. 

At  night,  and  especially  toward  morning,  chilling  of  the  abdomen 
should  be  prevented  by  wearing  a  long  undershirt  or  by  throwing  a 
blanket  over  the  body. 
24 


PART  VIII 

RIDING,  PACKING,  AND  DRIVING 


CHAPTER   I 

RIDING 


War  Department  orders  provide  that  at  posts  where  there  are 
mounted  troops  the  necessary  instruction  of  the  hospital  corps  in 
riding  shall  be  given  by  troop  or  mounted  detachment  commanders 
in  connection  with  the  instruction  of  their  troops.  At  other  posts, 
however,  the  instruction  must  be  given  under  the  direction  of  medi- 
cal officers  whenever  the  necessary  animals  are  available.  The  fol- 
lowing course  of  instruction  is  taken  from  the  Cavalry  Drill  Regu- 
lations modified  to  meet  the  requirements  of  the  hospital  corps : 

****>!«*** 

270.  The  order  of  instruction  indicated  may  be  modified  at  the  discretion 
of  the  officer  superintending,  care  being  taken  to  develop  the  confidence  of 
the  recruit  by  progress  suited  to  his  capacity,  and  which  will  exempt  him  as 
far  as  possible  from  falls  or  other  accidents. 

During  the  first  few  lessons  the  instructor  will  devote  his  attention  chiefly 
to  giving  to  the  recruits  the  proper  seat  and  carriage  and  to  making  them  self- 
confident  on  horseback;  he  will  quietly  and  patiently  correct  the  faults  of 
each  individual  as  they  occur,  frequently  passing  from  one  to  another,  and 
will  require  by  degrees  the  correct  execution  of  his  teachings ;  these  under- 
stood and  confidence  imparted,  the  positions  and  motions  will  then  be  rigidly 
enforced. 

271.  Each  mounted  drill  begins  and  ends  at  the  walk.     This  rule  is  general. 

272.  During  the  drills  the  recruits  are  taught  the  following  rules  for  the 
care  of  horses,  until  the  instructor  is  satisfied  by  means  of  questions  that 
they  are  thoroughly  comprehended : 

Never  threaten,  strike,  or  otherwise  abuse  a  horse. 
Before  entering  a  stall,  speak  to  the  horse  gently  and  then  go  in  quietly. 
Never  take  a  rapid  gait  until  the  horse  has  been  warmed  up  by  gentle 
exercise. 

(371) 


372  RIDING,  PACKING,  AND  DRIVING 

Never  put  up  a  horse  brought  in  a  heated  condition,  to  the  stable  or  picket 
line,  but  throw  a  blanket  over  him  and  rub  his  legs,  or  walk  him  until  cool. 
When  he  is  wet,  put  him  under  shelter,  and  wisp  him  until  dry. 

Never  feed  grain  to  a  horse  nor  allow  him  to  stand  uncovered  when 
heated.     Hay  will  not  hurt  a  horse,  no  matter  how  warm  he  may  be. 

Never  water  a  horse  when  heated  unless  the  exercise  or  march  is  to  be 
immediately  resumed. 

Never  throw  water  over  any  part  of  a  horse  when  heated. 

Never  allow  a  horse's  back  to  be  cooled  suddenly,  by  washing  or  even  re- 
moving the  blanket  unnecessarily. 

To  cool  the  back  gradually,  the  blanket  may  be  removed  and  replaced 
with  the  dry  side  next  the  horse. 

The  Equpment  of  the  Horse 

273.  The  instructor  indicates  the  different  parts  and  uses  of  each,  equip- 
ment as  a  commencement  of  this  instruction. 

To  Fold  the  Saddle  Blanket 

274.  The  blanket,  after  being  well  shaken,  will  be  folded  into  six  thick- 
nesses, as  follows :  Hold  it  well  up  by  the  two  corners,  the  long  way  up  and 
down;  double  it  lengthwise  (so  the  fold  will  come  between  the  "U"  and 
"  S  "),  the  folded  comer  (middle  of  blanket)  in  the  left  hand;  take  the  folded 
comer  between  the  thumb  and  forefinger  of  the  right  hand,  thumb  pointing 
to  the  left ;  slip  the  left  hand  down  the  folded  edge  two-thirds  its  length  and 
seize  it  with  the  thumb  and  second  finger;  raise  the  hands  to  the  height  of 
the  shoulders,  the  blanket  between  them  extended;  bring  the  hands  together, 
the  double  fold  falling  outward;  pass  the  folded  corner  from  the  right  hand 
into  the  left  hand,  between  the  thumb  and  forefinger,  slip  the  second  finger 
of  the  right  hand  between  the  folds,  and  seize  the  double  folded  corner; 
turn  the  left  (disengaged)  comer  in,  and  seize  it  with  thumb  and  forefinger 
of  the  right  hand,  the  second  finger  of  the  right  hand  stretching  and  evening 
the  folds ;  after  evening  the  folds,  grasp  the  corners  and  shake  the  blanket 
well  in  order  to  smooth  the  folds,  raise  the  blanket  and  place  it  between  the 
chin  and  breast;  slip  the  hands  down  half-way,  the  first  two  fingers  outside, 
the  other  fingers  and  thumb  of  each  hand  inside,  seize  the  blanket  with  the 
thumbs  and  first  two  fingers,  let  the  part  under  the  chin  fall  forward;  hold 
the  blanket  up,  arms  extended,  even  the  lower  edges,  seize  the  middle  points 
between  the  thumbs  and  forefingers,  and  flirt  the  outside  part  over  the  right 
arm;  the  blanket  is  thus  held  before  placing  it  on  the  horse. 

The  blanket  should,  if  possible,  be  kept  dry  and  free  from  sand,  caked 
dandruff,  and  hairs.  It  should  be  frequently  shaken  out  and  well  switched, 
if  necessary,  to  restore  its  pliability  and  remove  dust  and  hair.  In  warm 
weather,  when  the  animal  sweats  freely,  a  fresh,  clean  bearing  surface  on 
the  blanket  should  be  placed  next  to  the  back. 

It  is  not  a  good  plan  to  dry  the  sweat-soaked  surface  of  a  folded  blanket 


RIDING  373 

in  the  sun  and  put  this  dried  surface  next  the  back  the  following  morning. 
Such  drying  hardens  the  dandruff  mixed  with  sweat  and  dust  that  is  always 
present,  and  makes  this  part  of  the  blanket  rough  and  hard.  It  is  preferable 
to  double  the  sweat-soaked  folded  blanket  on  itself,  so  it  will  remain  moist 
and  soft. 

To  Put  on  the  Blanket  and  Surcingle 

275.  The  instructor  commands  :    Blanket. 

Approach  the  horse  on  the  near  (left)  side,  with  the  blanket  folded  and 
held  as  just  described;  place  it  well  forward  on  his  back,  by  tossing  the  part 
of  the  blanket  over  the  right  arm  to  the  off  (right)  side  of  the  horse,  still 
keeping  hold  of  the  middle  points;  shde  the  blanket  once  or  twice  from 
front  to  rear  to  smooth  the  hair,  being  careful  to  raise  the  blanket  in  bringing 
it  forward;  place  the  blanket  with  the  forefinger  of  the  left  hand  on  the 
withers,  and  the  forefinger  of  the  right  hand  on  the  backbone,  the  blanket 
smooth;  it  should  then  be  well  forward  with  the  edges  on  the  left  side; 
remove  the  locks  of  mane  that  may  be  under  it;  pass  the  buckle  end  of  the 
surcingle  over  the  middle  of  the  blanket,  and  buckle  it  on  the  near  side,  a 
little  below  the  endge  of  the  blanket. 

To  Put  on  the  "Watering  Bridle 

276.  The  instructor  commands :  Bridle. 

Take  the  reins  in  the  right  hand,  the  bit  in  the  left;  approach  the  horse 
on  the  near  side,  slip  the  reins  over  the  horse's  head  and  let  them  rest  on  his 
neck;  reach  under  and  engage  the  snap  in  the  right  halter  ring,  insert  the 
left  thumb  in  the  side  of  the  horse's  mouth  above  the  tush  and  press  open 
the  lower  jaw;  insert  the  bit  and  engage  the  snap  in  the  left  halter  ring. 
The  bit  should  hang  so  as  to  touch,  but  not  draw  up,  the  comers  of  the 
mouth. 

To  Unbridle 

277.  At  the  command,  unbridle,  pass  the  reins  over  the  horse's  head  and 
disengage  the  snaps. 

The  Saddle  and  Bridle 

279.  Greatest  care  vnll  be  taken  in  the  fitting  of  the  saddles;  sore  backs 
are  generally  occasioned  by  neglect,  and  the  men  must  never  be  allowed  to 
lounge  or  sit  unevenly  in  their  saddles. 

To  Saddle 

280,  For  instruction,  the  saddle  may  be  placed  four  yards  in  rear  or  front 
of  the  horse.  The  stirrups  are  crossed  over  the  seat,  the  right  one  upper- 
most; then  the  cincha  and  cincha  strap  are  crossed  above  the  stirrups,  the 
strap  uppermost.  The  blanket  having  been  placed  as  previously  explained, 
the  instructor  commands :  Saddle. 


374 


RIDING,  PACKING,  AND  DRIVING 


Seize  the  pommel  of  the  saddle  with  the  left  hand  and  the  cantle  with  the 
right,  approach  the  horse  on  the  near  side  from  the  direction  of  the  croup 
and  place  the  center  of  the  saddle  on  the  middle  of  the  horse's  back,  the  end 
of  the  side  bar  about  three  fingers'  widths  behind  the  point  of  the  shoulder 
blade;  let  down  the  cincha  strap  and  cincha;  pass  to  the  off  side,  adjust  the 
cincha  and  straps  and  see  that  the  blanket  is  smooth;  return  to  the  near  side, 


Fig.  248. —  Nomenclature  of  the  Saddle.  A,  Pom- 
mel; B,  cantle;  C,  side  bar;  D,  E,  spider  (quarter 
straps);  F,  spider  (or  girth-strap)  ring;  G,  cincha; 
H,  cincha  strap;  /,  cincha  ring;  i,  cincha-ring  safe; 
K,  stirrup  loop;  L,  stirrup  strap;  M,  stirrup  tread; 
N,  stirrup  hood;  P,  shield;  Q,  stud;  7?,  R,  rings;  S,  S, 
saber  straps;  T,  staple;  a,  a,  a,  a,  coat  straps. 


Fig.     249. —  Nomenclature  of 

the       Bridle.          Headstall:  A, 

Crownpiece;    B,    brow    band;  C, 
ornament;     D,    D,    cheek    piece; 

E,     throatlatch.        Bit:       F.  F, 

mouth    piece;     G,    port;    H,  H, 

branches;    /,    /,    rein    rings;  K, 

curb   strap;   R,   reins.     Link:  L, 
link  strap;   M,  link  snap. 


raise  the  blanket  slightly  under  the  pommel  arch  so  that  the  withers  may  not 
be  compressed ;  take  the  cincha  strap  in  the  right  hand,  reach  under  the  horse 
and  seize  the  cincha  ring  with  the  left  hand,  pass  the  end  of  the  strap  through 
the  ring  from  underneath  (from  inside  to  outside),  then  up  and  through  the 
upper  ring  from  the  outside;  if  necessary  make  another  fold  in  the  same 
manner. 


RIDING  375 

The  strap  is  fastened  as  follows:  Pass  the  end  through  the  upper  ring 
to  the  front ;  seize  it  with  the  left  hand,  place  the  fingers  of  the  right  between 
the  outside  folds  of  the  strap;  pull  from  the  horse  with  the  right  hand 
and  take  up  the  slack  with  the  left;  cross  the  strap  over  the  folds,  pass 
the  end  of  it,  with  the  right  hand,  underneath  and  through  the  upper  ring 
back  of  the  folds,  then  down  and  under  the  loop  that  crosses  the  folds 
and  draw  it  tightly:  weave  the  ends  of  the  strap  into  the  strands  of  the 
cincha. 

Another  method  of  fastening  the  cincha  strap  is  as  follows:  Pass  the 
end  through  the  upper  ring  to  the  rear;  seize  it  with  the  right  hand,  place 
the  fingers  of  the  left  between  the  outer  folds  of  the  strap;  pull  from  the 
horse  with  the  left  hand  and  take  up  the  slack  with  the  right;  pass  the 
end  of  the  strap  underneath  and  draw  it  through  the  upper  ring  until  a 
loop  is  formed;  double  the  loose  end  of  the  strap  and  push  it  through  the 
loop  and  draw  the  loop  taut.  The  free  end  should  then  be  long  enough 
to  conveniently  seize  with  the  hand. 

Having  fastened  the  cincha  strap,  let  down  the  right  stirrup,  then  the  left. 

The  surcingle  is  then,  buckled  over  the  saddle  and  should  be  a  little  looser 
than  the  cincha. 

The  cincha  when  first  tied  should  admit  a  finger  between  it  and  the  belly. 
After  exercising  for  a  while  the  cincha  will  be  found  too  loose  and  should 
be  tightened. 

The  cincha  should  not  be  unduly  tightened.  Tight  cinching  causes  young 
animals  to  rear  and  even  throw  themselves.  It  induces  local  swellings  and 
galls,  by  interfering  with  the  circulation,  and  it  teaches  all  saddle  animals  to 
inflate  the  lungs  ("swell  themselves")  the  moment  they  feel  the  touch  of 
the  cincha.     On  cold  mornings  tight  cinching  causes  even  old  saddlers  to  buck. 

Take  up  the  cincha  gently  and  draw  it  snugly,  then  secure  it  temporarily. 
Adjust  your  stirrups  and  see  that  they  are  of  equal  length.  This  can  be 
judged  by  standing  in  front  of  the  animal  and  comparing  one  with  the  other. 
It  will  be  found  that  from  the  often  repeated  mounting  and  dismounting  on 
the  near  side  the  stirrup  leather  of  that  side  will  usually  be  found-  longer 
than  the  other.  Having  adjusted  things  generally,  return  to  the  cincha  and 
take  up  the  slack  that  will  now  be  found,  draw  it  snugly  but  not  tightly,  and 
secure  it,  being  careful  that  there  are  no  wrinkles  in  the  strap  and  that  the 
cincha  itself  does  not  encroach  on  the  quarter  strap  ring  shield.  If  it  does, 
either  the  cincha  strap  is  too  long  on  the  off  side  or  the  cincha  is  too  long. 
In  either  event,  make  the  necessary  correction  at  once,  if  possible.  If  this 
correction  is  not  made  soon,  a  gall  may  be  expected. 

281.  To  approximate  the  length  of  the  stirrup  straps  before  mounting,  they 
are  adjusted  so  that  the  length  of  the  stirrup  strap,  including  the  stirrup,  is 
about  one  inch  less  than  the  length  of  the  arm,  fingers  extended. 

To  Unsaddle 

282.  The  instructor  commands :  Unsaddle. 

Stand  on  the  near  side  of  the  horse ;  unbuckle  and  remove  the  surcingle ; 


376  RIDING,  PACKING,  AND  DRIVING 

cross  the  left  stirrup  over  the  saddle;  loosen  the  cinoha  strap  and  let  down 
the  cincha;  pass  to  the  off  side,  cross  the  right  stirrup,  then  the  cincha; 
pass  to  the  near  side,  cross  the  cincha  strap  over  the  saddle;  grasp  the 
pommel  with  the  left  hand,  the  cantle  with  the  right,  and  remove  the  saddle 
over  the  croup  and  place  it  in  front  or  rear  of  the  horse  as  may  be  directed, 
pommel  to  the  front;  grasp  the  blanket  at  the  withers  with  the  left  hand 
and  at  the  loin  with  the  right,  remove  it  in  the  direction  of  the  croup,  the 
edges  falling  together,  wet  side  in,  and  place  it  across  the  saddle,  folded  edge 
on  the  pommel. 

If  in  the  stable,  piace  the  saddle  on  its  peg  when  taken  off  the  horse. 

On  arriving  in  camp  and  having  dismounted,  ease  off  the  cincha  about  3 
inches  and  change  the  bearing  of  the  saddle  by  moving  it  to  rear  or  front 
at  least  an  inch.  Allow  the  saddle  to  remain  on  the  back  for  ten  or  twelve 
minutes,  to  enable  the  almost  bloodless  skin  beneath  (caused  by  weight  of 
yourself  and  pack)  and  the  tired  saddle  bed  muscles  to  regain  to  some  extent 
their  lost  tone,  while  you  busy  yourself  about  the  bridle  and  halter,  and  the 
religious  duty  of  closely  examining  the  feet  for  loose  shoes,  rocks,  nails, 
bruises,  thrush,  and  interfering  sores.  Now  remove  the  saddle,  turn  over 
the  blanket,  and  let  that  remain  in  place  until  the  back  has  dried. 

If  any  dry  spots  are  noticed  on  the  sweaty  skin  while  the  blanket  is  being 
turned  over,  remember  they  are  inflammations  of  the  skin,  produced  by 
unequal  distribution  of  weight,  and  are  liable  to  puff  up  later  if  not  attended 
to.  Mark  their  location  well,  for  you  are  close  to  the  walking  stage  if  you 
neglect  them.  When  the  back  is  dry,  remove  the  blanket  and  take  care  of  it. 
Massage  well  from  front  to  rear  the  spots  referred  to,  bathe  the  saddle  bed 
with  clean  water,  dry  it,  and  let  the  animal  roll  if  he  will.  Should  small 
swellings  appear,  however,  keep  the  blanket  in  place  until  a  soaking  wet 
gunny  sack  is  procured.  Now  remove  the  blanket,  massage  the  swelling 
vigorously,  and  put  the  wet  folded  gunny  sack  pack  over  the  back  and  secure 
it  there.  Do  not  allow  the  animal  to  roll  if  it  can  be  avoided,  and  keep  the 
pack  wet  during  the  night.  In  the  majority  of  cases  the  animal  will  be 
ready  for  careful  saddling  in  the  morning. 

Should  you  have  produced  a  gall,  the  place  should  be  bathed  and  dis- 
infected with  creolin  or  carbolic-acid  solution  (i  ounce  to  the  quart  of  water), 
the  spot  protected  from  the  flies,  cold-packed  if  necessary,  and  the  animal 
led  until  nature  effects  a  cure.  Close  attention  to  cleanliness,  disinfection, 
and  stimulation  of  the  wound  will  hasten  the  process.  Use  a  solution  of 
aloes  or  alum  in  water  (one-half  ounce  of  either  to  a  pint  of  water)  as  a 
stimulant. 

Even  with  very  close  attention  to  saddling,  galls  may  be  produced  if  the 
rider  is  not  a  careful  one. 

Irrespective  of  the  fit  of  the  saddle  and  condition  of  the  blanket,  the  things 
that  cause  galls  and  "  bunches  "  most  frequently  are  carelessness  in  balancing 
and  securing  the  pack,  a  lounging,  shifting  seat,  and  a  sloppy  method  of 
handling  the  reins,  inattention  to  proper  cinching,  unequal  length  of  stirrups, 
neglect  of  adjustment  at  the  halts,  the  riding  of  a  lame  animal,  and  the 
galloping  of  a  leg-weary  one. 


RIDING  377 

To  Put  on  the  Curb  Bridle 

283.  The  instructor  commands  :    Bridle. 

Take  the  reins  in  the  right,  the  crovvnpiece  in  the  left  hand;  approach 
the  horse  on  the  near  side,  passing  the  right  hand  along  his  neck;  slip  the 
reins  over  his  head  and  let  them  rest  on  his  neck;  take  the  crownpiece  in 
the  right  hand  and  the  lower  left  branch  of  the  bit  in  the  left  hand,  the 
forefinger  against  the  mouthpiece;  bring  the  crownpiece  in  front  of  and 
slightly  below  its  proper  position;  insert  the  thumb  into  the  side  of  the 
mouth  above  the  tush;  press  open  the  lower  jaw,  insert  the  bit  by  raising 
the  crownpiece,  with  the  left  hand  draw  the  ears  gently  under  the  crown- 
piece, beginning  with  the  left  ear;  arrange  the  forelock,  secure  the  throat- 
latch,  and  then  the  curb  strap,  taking  care  not  to  set  them  too  closely. 

284.  The  mouthpiece,  which  should  fit  the  width  of  the  horse's  mouth, 
rests  on  that  part  of  the  bars  (the  lower  jaw  between  the  tushes  and  molars) 
directly  opposite  the  chin  groove;  the  curb  strap  should  then  lie  in  the 
chin  groove  without  any  tendency  to  mount  up  out  of  it  on  the  sharp  bones 
of  the  lower  jaw.  This  position  of  the  mouthpiece  will  be  attained  for 
the  majority  of  horses  by  adjusting  the  cheek  straps  so  that  the  mouth- 
piece will  be  one  inch  above  the  tushes  of  the  horse  and  two  inches  above 
the  corner  teeth  of  the  mare. 

The  throatlatch  should  admit  four  fingers  between  it  and  the  throat; 
this  prevents  constriction  of  the  windpipe  or  pressure  on  the  large  blood- 
vessels. 

The  curb  strap  should  fit  smoothly  the  chin  groove,  and  be  loose  enough 
to  admit  one  or  two  fingers  when  the  branches  of  the  bit  are  in  line  with 
the  cheek  straps. 

285.  At  the  discretion  of  the  instructor,  the  halter  may  be  taken  off  before 
bridling,  the  reins  being  first  passed  over  the  neck;  the  hitching  strap,  if 
not  left  at  the  manger  or  picket  line,  is  tied  around  the  horse's  neck;  if 
the  horse  be  saddled,  in  the  near  pommel  ring. 

To  Unbridle 

286.  The  instructor  commands :     Ubridle. 

Stand  on  the  near  side  of  the  horse;  pass  the  reins  over  the  horse's  head, 
placing  them  on  the  bend  of  the  left  arm;  unbuckle  the  throatlatch,  grasp 
the  crownpiece  with  the  right,  and  assisting  with  the  left  hand  gently  dis- 
engage the  ears;  grasp  the  bit  with  the  left  hand,  and  gently  disengage  it 
from  the  horse's  mouth  by  lowering  the  crownpiece;  place  the  crownpiece 
in  the  palm  of  the  left  hand,  take  the  reins  in  the  right  hand,  pass  them 
together  over  the  crownpiece,  make  two  or  three  turns  around  the  bridle, 
then  pass  the  bight  between  the  brow  band  and  crownpiece  and  draw  it  snug. 

The  bridle  is  hung  up  by  the  reins,  or  placed  across  the  saddle  on  the 
blanket. 

If  the  horse  has  no  halter  on,  unbridle  and  push  the  bridle  back  so  that 
the  crownpiece  will  rest  on  the  neck  behind  the  poll  until  the  halter  is 
replaced. 


378  RIDING,  PACKING,  AND  DRIVING 

To  Mount  (without  saddle) 

293.  I.  Prepare  to  Mount.    2.  Mount. 

At  the  first  command,  drop  the  right  rein,  take  two  back  steps,  stepping 
off  with  the  left  foot,  at  the  same  time  shding  the  right  hand  along  the 
left  rein;  face  to  the  right.  This  Should  place  the  trooper  behind  the  near 
shoulder  of  the  horse.  Take  both  reins  in  the  right  hand,  aided  by  the  left, 
the  reins  coming  in  on  the  side  of  the  forefinger,  forefinger  between  the 
reins,  the  loose  end  falling  over  on  the  off  side;  place  the  right  hand  behind 
the  withers,  holding  the  reins  short  enough  to  feel  lightly  the  horse's  mouth ; 
place  the  left  hand  near  the  withers,  and  grasp  a  lock  of  the  mane,  the 
lock  coming  out  between  the  thumb  and  forefinger. 

At  the  command  mount,  spring  lightly  from  the  ground  and  raise  the 
body,  keeping  it  erect,  and  supporting  the  weight  on  the  hands ;  carry  the 
right  leg,  knee  bent,  over  the  horse's  back,  the  weight  still  borne  on  the 
hands;  sit  down  gently  on  the  horse's  back,  and  take  one  rein  in  each  hand, 
the  reins  bearing  equally  on  the  horse's  mouth. 

In  the  earlier  lessons,  the  recruit  may  rest  the  right  forearm  on  the  horse's 
back  to  enable  him  to  raise  the  body  when  mounting. 

Position  of  the  Trooper  (without  saddle) 

294.  Body  balanced  on  the  middle  of  the  horse's  back. 
Head  erect  and  square  to  the  front. 

Chin  slightly  drawn  in. 

Shoulders  square  and  well  thrown  back. 

Chest  pushed  out. 

Back  straight. 

Elbows  slightly  to  the  rear  of  the  points  of  the  shoulders. 

Forearms  horizontal  and  close  to  the  sides  without  pressure. 

The  right  rein  in  the  right  hand,  and  the  left  rein  in  the  left  hand,  coming 
in  on  the  underside  of  the  little  finger,  and  coming  out  over  the  second 
joint  of  forefinger,  on  which  the  thumb  firmly  holds  the  rein;  the  other 
fingers  closed  on  the  reins,  nails  toward  the  body;  reins  bearing  equally  on 
the  horse's  mouth;  bight  (end)  of  reins  falling  to  the  front  and  on  the  right 
side  of  the  horse's  neck. 

Hands  about  six  inches  apart,  on  a  level  with  the  elbows,  backs  straight 
up  and  down  and  outward. 

Buttocks  bearing  equally  on  the  middle  of  the  horse's  back,  the  seat  being 
as  flat  as  possible. 

Legs  stretched  by  their  weight  alone,  the  flat  of  the  thighs  and  knees 
clasping  the  horse  equally. 

Legs  from  knees  down  vertical  and  free. 

Feet  parallel  to  the  sides  of  the  horse,  or  as  nearly  so  as  the  conformation' 
of  the  man  will  permit. 


RIDING  ■  379 

Remarks  on  the  Position  of  the  Trooper 

Body  balanced  on  the  middle  of  the  horse's  hack,  because  that  is  the  point 
where  the  motion  of  the  horse  is  least  communicated  to  the  rider,  and  the 
best  weight-bearing  position  for  the  horse. 

Head  erect  and  square  to  the  front.  If  not,  the  body  will  incline  forward 
or  to  one  side  and  be  unsteady. 

Chin  slightly  drawn  in.  To  prevent  the  head  and  shoulders  from  drooping 
to  the  front. 

Shoulders  square  and  well  thrown  back  and  the  chest  pushed  out.  If  not, 
the  chest  will  be  contracted  and  the  back  curved  to  the  rear. 

Back  straight.  This  gives  an  erect  carriage  and  counteracts  the  tendency 
to  slouch  or  droop  the  shoulders. 

Elbows  slightly  to  the  rear  of  the  shoulders.  To  assist  in  keeping  the 
shoulders  back. 

Forearms  horizontal  and  colse  to  the  sides  without  pressure.  To  prevent 
their  being  thrown  out  when  the  horse  trots;  if  with  pressure,  the  motion 
of  the  body  will  be  communicated  to  the  hand  and  rein. 

Buttocks  bearing  equally,  and  seat  as  flat  as  possible.  So  that  the  body 
will  preserve  its  steadiness. 

Flat  of  thighs  and  knees  clasping  the  horse  equally.  To  give  a  firm,  steady 
seat. 

Legs  from  knees  down  vertical  and  free.  That  they  may  be  carried  to  the 
rear  to  aid  in  directing  the  horse  without  defanging  the  seat. 

Feet  parallel  to  the  horse.    To  assist  in  holding  the  thighs  in  position. 

The  body  from  the  hips  up  should  be  movable,  and  should,  in  a  measure, 
yield  to  the  motions  of  the  horse;  from  the  hips  to  the  knees,  immovable 
and  close  to  the  horse;  from  the  knees  down,  movable. 

The  arms  move  freely  at  the  shoulders  to  avoid  communicating  the  motion 
of  the  body  to  the  reins,  the  hands  oscillate  slightlj'-  with  the  motion  of  the 
horse,  but  otherwise  they  are  stationary,  except  to  direct  the  horse. 

During  the  earlier  lessons  the  position  of  the  recruit  is  necessarily  one 
of  constraint. 

No  man  can  be  said  to  be  a  good  horseman  wiho  has  not  a  firm,  well- 
balanced  seat;  it  is  therefore  of  the  utmost  importance;  it  will  assist  the 
horse;  the  want  of  it  will  impede  the  horse's  actions,  make  sore  backs,  etc. 


To  Lengthen  or  Shorten  the  Reins 

295.  Bring  the  hands  toward  each  other ;  grasp  the  right  rein  with  the 
thumb  and  forefinger  of  the  left  hand  a  short  distance  from  the  right  thumb; 
relax  the  grasp  of  the  right  hand,  and  allow  the  rein  to  slip  through  to  get 
the  proper  bearing;  then  close  the  right  hand  and  replace  the  hands.  With 
the  left  rein  the  positions  of  the  hands  are  reversed. 


380  RIDING,  PACKING,  AND  DRIVING 

To  Take  the  Keins  in  One  Hand 

296.  To  relieve  the  constraint  of  the  arms  by  changing  their  position,  as 
well  as  to  prepare  the  recruits  for  the  use  of  the  curb  bridle,  the  instructor 
commands:     i.  In  left  (or  right)  hand.    2.  Take  Reins. 

At  the  second  command,  bring  the  left  hand  opposite  the  middle  of  the 
body;  half  open  and  place  in  it  the  right  rein,  holding  both  reins  as  explained 
for  the  left  rein,  except  that  the  little  finger  separates  the  reins,  the  right  rein 
coming  in  above  the  little  finger ;  close  the  left  hand  and  drop  the  right  hand 
behind  the  thigh. 

To  Adjust  the  Keins 

297.  Seize  the  bight  with  the  thumb  and  forefinger  of  the  right  hand,  partly 
open  the  left  hand  so  as  to  allow  the  reins  to  slip  through  it;  raise  the  right 
hand  until  the  reins  bear  equally;  close  the  left  hand  upon  them  letting  the 
bight  fall  over  the  forefinger  and  right  rein;  drop  the  right  hand. 

To  Betake  the  Beins  in  Both  Hands 

298.  The  reins  being  in  the  left  hand:     i.  In  both  hands.    2.  Take  Reins. 
Half  open  the  left  hand,  seize  with  the  right  hand  the  right  rein,  and  hold 

them  as  previously  described. 

To  Drop  and  Retake  Be  ins 

299.  Drop  Reins  :  Drop  the  reins  on  the  horse's  neck  near  the  withers 
and  drop  the  hands  behind  the  thighs. 

Take  Reins  :  The  trooper  retakes  the  reins  and  holds  them  as  before 
dropping  them. 

To  Dismount  (without  saddle) 

300.  I,  Prepare  to  Dismount.    2.  Dismount. 

At  the  first  command,  pass  the  right  rein  into  the  left  hand,  then  seize  both 
reins  with  the  right  hand  in  front  of  the  left,  forefinger  between  the  reins, 
and  place  the  right  hand  on  the  withers,  the  reins  coming  into  the  hand  on 
the  side  of  the  forefinger;  let  go  with  the  left  hand  and  grasp  a  lock  of  the 
mane  in  front  of  the  withers,  the  lock  coming  out  between  the  thumb  and 
forefinger. 

At  the  command  dismount,  raise  the  body  on  both  hands,  carry  the  right 
leg,  knee  bent,  over  the  horse's  back  without  touching  it ;  bring  the  right  leg 
near  the  left  and  come  lightly  to  the  ground  on  the  balls  of  the  feet,  bending 
the  knees  a  little ;  face  to  the  left,  drop  the  right  rein,  step  to  the  front,  sliding 
the  right  hand  along  the  left  rein,  and  take  the  position  or  stand  to  horse. 

To  Dismount  on  the  Off  Side 

301.  I.  To  the  right.    2.  Prepare  to  Dismount.    3.  Dismount. 

The  second  and  third  commands  are  executed  as  in  par.  300,  but  by  inverse 
means,  the  trooper  coming  to  the  ground  on  the  off  side. 


RIDINQ  381 

To  Mount  from  the  OfE  Side 

302.  The  trooper  being  dismounted  and  on  the  off  side  of  his  horse,  i.  Pre- 
pare TO  Mount.    2.  Mount. 

The  commands  are  executed  as  in  par.  293,  but  by  inverse  means. 

The  Aids  in  Horsemanship 

311.  The  training  of  the  new  horse  involves  the  infliction  of  more  or  less 
pain,  the  necessity  for  which  becomes  less  as  his  intelligence  is  quickened 
into  understanding  the  lightest  pressure. 

A  horse  is  bit-wise  when  (the  bit  being  correctly  fitted  and  properly  ad- 
justed, par.  284)  he  obeys  the  lightest  pressure  upon  either  bar. 

He  is  rein-wise  when  he  obeys  the  lightest  pressure  of  the  rein  on  either 
side  of  the  neck,  the  bit  not  being  disturbed  from  its  normal  position. 

He  is  leg-wise  when  he  obeys  the  lightest  correctly  combined  action  of  the 
rider's  legs. 

The  most  thoughtful  care  should  be  constantly  exercised  in  the  combined 
applications  of  the  aids,  that  they  may  not  be  opposed  to  each  other  in  their 
action,  i.  e.,  one  favoring  the  intended  move,  the  other  opposing  it. 

Preparatory  to  the  movements,  the  instructor  mounts  the  squad  and 
explains  the  uses  of  the  reins  and  legs. 

The  reins  and  legs,  the  application  of  which  determines  the  movements 
and  gaits  of  the  horse,  are  called  the  aids. 

The  trooper  should  not  only  know  when  to  apply  a  given  aid,  but  he  should 
also  understand  why  he  applies  it. 

The  reins  serve  to  prepare  the  horse  to  move,  and  to  guide,  support,  and 
halt  him;  their  action  should  be  gradual  and  in  harmony  with  that  of  the 
legs. 

In  using  them  the  arms  should  have  free  action  at  the  shoulder;  when  a 
light  pressure  will  be  sufficient  to  govern  the  horse,  the  action  of  the  hand 
should  be  at  the  wrist ;  for  greater  pressure,  the  elbow  should  be  carried  back, 
but  without  raising  the  hand. 

In  riding,  the  bridle  hand  should  be  kept  steady  and  ought  not  to  move 
with  the  body;  it  should  merely  oscillate  with  the  motion  of  the  horse's  head; 
at  the  same  time  it  must  be  kept  light,  for  the  bit  causes  pain  if  pressed  con- 
stantly on  the  mouth,  destroys  its  sensibility,  and  makes  the  horse's  mouth 
hard. 

The  hand  is  light  when  there  is  an  almost  imperceptible  alternate  feeling 
and  easing  of  the  hand  in  harmony  with  the  motion  of  the  horse,  by  which 
the  delicacy  of  the  mouth  is  preserved,  and  the  horse  made  to  carry  himself 
light. 

That  hand  is  best  which,  by  giving  and  taking  properly  and  keeping  con- 
stant touch  of  the  bit,  controls  the  horse  with  the  least  force,  and  will  best 
preserve  the  mouth. 

As  a  rule,  it  is  recommended  that  recruits  ride  with  one  rein  in  each  hand; 
this  will  prevent  the  bad  habit  of  holding  the  left  shoulder  advanced. 

The  legs  serve  to  assist,  together  with  the  reins,  in  controlling  the  horse. 


382  RIDING,  PACKING,  AND  DRIVING 

Closing  the  knees,  without  pressure  by  the  lower  part  of  the  leg,  tends  to 
steady  the  horse  in  position.  Carrying  the  lower  legs  slightly  to  the  rear, 
closing  them  equally  with  slight  pressure,  prepares  him  to  move,  or,  if  moving, 
to  keep  him  up  to  the  hand.  Closed  with  greater  pressure  behind  the  girth, 
they  urge  him  forward. 

Carrying  the  right  (or  left)  leg  to  the  rear,  closing  it  with  pressure,  causes 
the  horse  to  move  his  haunches  to  the  left  (or  right). 

The  pressure  of  the  legs  must  be  an  elastic  muscular  action,  suited  to  the 
sensitiveness  of  the  horse ;  a  heavy,  clinging  pressure  or  dull  thumping  with 
the  heels  must  not  be  permitted. 

The  reins  act  to  direct  the  forehand;  the  lower  legs  incite  to  action  and 
govern  the  movement  -of  the  haunches. 

All  changes  of  gait  are  made  gradually.  The  horse  should  never  be  spurred 
to  make  a  sudden  start,  nor  should  the  retrs  be  jerked.  j 

To  Trot 

332.  Being  at  the  walk:     1.  Trot  (or  Slow  iron.    2.  March. 
At  the  command  trot,  gather  the  horse. 

At  the  command  march,  yield  the  hands  a  little  and  close  the  legs  by  degrees 
until  the  horse  obeys,  then  the  hands  are  gradually  replaced  and  the  legs 
relaxed. 

The  gait  is  slow  at  first,  and  the  instructor  sees  that  the  troopers  feel  lightly 
their  horses'  mouth  without  bearing  upon  the  reins,  and  explains  that  the 
necessary  ease  and  stability  are  acquired  by  setting  well  down  on  the  horse, 
or  saddle,  and  partially  relaxing  the  body,  thighs  and  legs,  the  hands  oscillat- 
ing with  the  motion  of  the  horse's  head. 

He  requires  the  troopers  to  preserve  their  seats  by  balancing  the  body; 
that  they  avoid  the  common  fault  of  leaning  the  body  too  far  or  curving 
the  back  to  the  rear ;  that  they  sit  erect  and  keep  the  thighs  close  to  the  horse. 

To  Pass  from  the  Trot  to  the  Walk 

333.  Being  at  the  trot :     i.  Walk,    2.  March. 
At  the  command  walk,  gather  the  horse. 

At  the  command  march,  rein  in  by  degrees,  and  hold  the  legs  close  to 
prevent  the  horse  from  coming  to  the  halt;  as  soon  as  he  walks,  replace  the 
hands  gradually  and  relax  the  legs. 

To  Mount  (with  saddle) 

344.  The  horses  equipped  with  saddles  and  curb  bridles  are  habitually 
formed  in  line.  The  troopers  standing  to  the  horse,  the  instructor  causes 
them  to  count  fours,  and  commands :     i.  Prepare  to  Mount.    2.  Mount. 

At  the  first  command  the  odd  numbers  lead  out. 

All  the  troopers  drop  the  right  rein,  take  two  back  steps,  stepping  off 
with  the  left  foot,  at  the  same  time  sliding  the  right  hand  along  the  left 
rein;  half   face  to  the  right;  this  should  place  the  trooper  about  opposite 


RIDING  383 

the  girth;  with  the  aid  of  the  left  hand  take  both  reins  in  the  right,  fore- 
finger between  the  reins,  and  place  the  right  hand  on  the  pommel,  the 
reins  coming  into  the  hand  on  the  side  of  the  forefmger,  and  held  so  as  to 
feel  hghtly  on  the  horse's  mouth,  the  bight  falling  on  the  off  side.  (TWO.) 
Place  a  third  of  the  left  foot  in  the  stirrup,  with  the  assistance  of  the  left 
hand  if  necessary,  and  support  it  against  the  forearm  of  the  horse;  rest 
upon  the  ball  of  the  right  foot,  grasp  a  lock  of  the  mane  with  the  left  hand, 
the  lock  coming  out  between  the  thumb  and  forefinger. 

At  the  command  mount,  spring  from  the  right  foot,  holding  firmly  to  the 
mane  and  keeping  the  right  hand  on  the  pommel;  pass  the  right  leg,  knee 
bent,  over  the  croup  of  the  horse  without  touching  him;  sit  down  in  the 
saddle;  let  go  the  mane,  insert  the  right  foot  in  the  stirrup,  pass  the  reins 
into  the  left  hand  and  adjust  them. 

At  the  command :  3.  Form.  4.  Rank,  the  even  numbers  move  up  in  their 
intervals. 

Position  of  the  Trooper  (with  saddle) 

345.  Same  as  previously  explained  (par.  294),  with  the  following  excep- 
tions :  Buttocks  bearing  equally  and  as  flat  as  possible  upon  the  middle  of 
the  saddle;  reins  coming  into  the  left  hand  on  the  side  of  the  Uttle  finger, 
and  leaving  it  between  thumb  and  forefinger;  little  finger  between  the 
reins,  right  rein  above  it;  the  other  fingers  closed,  thumb  pointing  to  the 
right  front  in  prolongation  of  the  forearm  and  pressing  the  reins  firmly 
on  second  joint  of  forefinger;  the  end  of  the  reins  falling  to  the  front  and 
outside  of  the  right  rein ;  left  forearm  horizontal  and  close  to  the  body 
without  pressure ;  the  back  of  the  hand  nearly  vertical ;  right  hand  behind 
the  thigh,  arm  hanging  naturally;  feet  inserted  in  the  stirrups  so  that  the 
ball  of  the  foot  rests  on  the  tread  of  the  stirrup,  heel  slightly  lower  than 
the  tread. 

Stirrups 

346.  The  stirrups  should  support  the  feet  and  the  weight  of  the  legs  only, 
and  be  of  such  length  that  when  the  legs  are  in  proper  position,  the  feet  out 
of  the  stirrups,  the  treads  will  be  on  a  level  with  the  lower  part  of  the  inner 
ankle  bone. 

The  length  depends  somewhat  on  the  formation  of  the  man;  a  man  with 
a  thick  heavy  thigh  requires  a  shorter  stirrup  than  a  man  with  a  thin,  flat 
one.  For  long  distances  at  the  gallop  and  trot,  a  shorter  stirrup  is  required 
than  at  the  walk. 

When  riding,  the  stirrups  take  up,  in  a  measure,  the  weight  of  the  body 
in  its  descent  to  the  saddle,  by  a  yielding  of  the  ankles  to  prevent  shock. 
This  action  is  an  easy,  quick  stiffening  of  the  muscles  which  distributes  the 
downward  motion  between  the  feet,  thighs,  and  seat. 

If,  after  the  trooper  has  been  exercised  a  short  time  at  the  slow  trot,  he 
has  a  close  seat,  his  leg  in  proper  position,  with  his  heel  down,  but  does  not 
easily  keep  his  stirrup,  then  the  stirrup  requires  shortening. 


384  RIDING,  PACKING,  AND  DRIVING 

stable  Duty 

995.  A  noncommissioned  officer,  designated  stable  sergeant,  or  corporal, 
is  detailed  in  each  detachment  to  take  immediate  general  charge  of  the  forage 
and  stable.  He  is  held  responsible  for  the  proper  policing  and  sanitary 
condition  of  the  stable,  picket  hne,  and  ground  pertaining  to  them.  One 
or  more  men,  called  stable  police,  are  detailed  for  the  p-urpose  of  policing, 
removing  manure,  feeding,  etc.,  under  the  direction  of  the  stable  sergeant. 

Usually  horses  are  groomed  twice  daily,  at  morning  and  at  evening 
stables,  under  the  supervision  of  the  stable  sergeant  and  a  commissioned 
officer.  Under  special  circumstances,  it  may  be  advisable  to  groom  only 
once  a  day. 

The  stable  police,  after  grooming  their  own  horses  at  morning  stables, 
clean  out  the  stalls  and  police  the  stable,  under  the  direction  of  the  stable 
sergeant.  The  bedding  is  taken  up,  that  which  is  much  soiled  being  separated 
for  the  manure  heap,  and  the  remainder  put  on  the  Htter  racks  or  spread 
upon  the  ground  to  dry. 

At  or  before  evening  stables,  the  stable  is  policed;  the  bedding  is  laid 
down  and  fresh  straw  spread  on  top  of  it;  the  bed  must  be  soft  and  even, 
with  the  thickest  part  toward  the  manger;  where  horses  eat  their  bedding, 
the  old  litter  should  be  placed  on  top  of  the  new  straw. 

.Grooming 

The  grooming  is  always  done  at  the  picket  line,  except  in  stormy  weather. 
Stable  call  is  the  first  call  or  warning  call  for  stables,  and  precedes  assembly 
by  such  intervals  as  may  be  prescribed.  The  roll  having  been  called,  the 
detachment  is  marched  to  the  horses  or  stable,  and  upon  arrival  there  the 
first  sergeant  commands.  Commence  grooming ;  Fall  Out.  The  horses 
are  then  tied  on  the  picket  line,  if  not  already  there,  and  are  groomed  under 
the  direction  of  the  platoon  leader.  Each  man  habitually  grooms  his  own 
horse,  except  that  the  horses  of  the  sergeants,  first  class,  may,  at  the  discre- 
tion of  the  company  commander,  be  groomed  by  the  men  of  the  platoon  to 
which  these  horses  are  attached.  Drivers  and  wagoners  groom  the  animals 
assigned  to  them. 

For  the  purpose  of  proper  supervision  in  grooming,  feeding,  etc.,  the  horses 
of  the  men  not  assigned  to  platoons  and  other  supernumerary  horses,  will 
be  attached  to  platoons. 

At  stables,  each  man  examines  his  horse's  feet.  Horses  requiring  shoeing 
are  reported  to  the  noncommissioned  officer  in  charge  of  the  section,  who 
notifies  the  stable  sergeant. 

Each  horse  should  be  groomed  not  less  than  20  minutes,  and  as  much 
longer  as  may  be  necessary.  When  the  horses  of  any  platoon  are  sufficiently 
groomed,  the  platoon  leader  reports  that  fact  to  the  first  sergeant.  The 
platoon  at  the  discretion  of  the  detachment  commander,  may  then  lead  in, 
and  the  horses  will  be  led  to  their  stalls  and  properly  secured  under  the 
supervision  of  the  platoon  leader.  Should  the  officer  wish  to  inspect  the 
horses  of  any  platoon  or  of  the  whole  detachment  before  they  are  led  in. 


RIDING  385 

he  will  notify  the  platoon  leader  or  the  first  sergeant,  who  will  then  com- 
mand: Cease  grooming.  Stand  To  Heel;  each  man  stands  one  yard  in 
rear  of  and  facing  his  horse.  When  all  the  horses  have  been  groomed  and 
led  in,  and  the  grooming  kits  put  away,  the  sergeant  will  form  the  detach- 
ment, march  it  to  the  company  parade,  and  dismiss  it. 

If,  when  the  horses  are  inspected,  the  officer  finds  any  of  them  not  properly 
groomed,  he  will  direct  that  these  horses  be  left  at  the  picket  line  and  groomed 
under  the  supervision  of  a  noncommissioned  officer  detailed  for  that  purpose. 

To  Groom 

997.  Take  the  currycomb  in  the  right  hand,  fingers  over  back  of  comb; 
begin  on  the  near  side  at  the  upper  part  of  the  neck,  thence  proceed  to  the 
chest,  arms,  shoulders,  back,  belly,  flank,  loins,  and  croup  in  the  order  named. 
Then  go  to  the  off  side,  taking  the  comb  in  the  left  hand,  and  proceed  as 
before. 

The  currycomb  is  applied  gently  and  is  used  only  to  loosen  the  scurf  and 
matted  hair;  it  is  not  used  on  the  legs  from  the  knees  or  hocks  downward, 
except  to  carefully  loosen  dried  mud. 

Next,  take  the  brush  in  the  left  hand  and  change  the  currycomb  to  the 
right ;  begin  at  the  head  and  then  the  neck  on  the  near  side,  and  proceed 
in  the  same  order  as  in  currying,  brushing  also  the  parts  not  touched  by 
the  cornb;  on  the  off  side,  take  the  brush  in  the  right  hand,  the  currycomb 
in  the  left.  The  principal  working  of  the  brush  should  follow  the  direction 
of  the  hair,  but  in  places  difficult  to  clean,  it  may  be  necessary  to  brush 
against  it,  finishing  by  leaving  the  hair  smooth.  After  every  few  strokes 
clean  the  brush  from  dust  with  the  currycomb. 

Having  finished  with  the  brush,  rub  or  dust  off  the  horse  with  the  groom- 
ing cloth,  wipe  out  the  eyes,  ears,  and  nostrils,  and  clean  the  dock.  The 
skin,  under  the  flank  and  between  the  hind  quarters  must  be  soft,  clean,  and 
free  from  dust. 

Currycombs,  cards,  or  common  combs  must  never  be  applied  to  the  mane 
or  tail;  the  brush,  fingers,  and  cloth  are  freely  used  on  both. 

The  wisp  is  used  when  the  horse  comes  in  wet  from  exercise,  rubbing 
against  the  hair,  until  dry,  from  his  hind  quarters  up  to  his  head.  If  very 
wet,  very  hot,  or  very  cold,  blanket  the  horse,  groom  and  hand-rub  the  legs ; 
then  remove  the  blanket  and  groom  the  body. 

Feeding 

998.  Guiding  principles  in  feeding  are:  (i)  Feed  in  small  quantities  and 
often:  (z)  Do  not  work  the  animal  hard  immediately  after  a  full  meal.  In 
garrison  and  on  the  march,  animals  should  be  fed  at  reveille,  at  mid-day,  and 
at  night,  ordinarily  one-third  of  the  grain  ration  being  given  each  time.  In 
garrison,  the  stable  sergeant,  assisted  by  members  of  the  stable  guard  or 
police,  may  feed  at  first  call  for  reveille.  In  the  evening,  grain  should  be 
fed  after  hay  has  been  distributed,  the  stable  swept  out  and  the  dust  thoroughly 
settled. 

25 


386  RIDING,  PACKING,  AND  DRIVING 

The  men  are  marched  to  the  forage  wagons  or  other  g,rain  depository  where 
the  noncommissioned  officer  in  charge,  with  an  allowance  measure,  issues  to 
each  in  turn. 

The  platoon  leaders  then  march  their  platoons  back  to  the  horses  and 
command :  Feed.  Ordinarily  one  man  of  each  platoon  will  remain  near  the 
horses  until  they  have  finished  eating,  to  adjust  feed  bags.  Each  man  may 
be  required  to  feed  and  groom  as  soon  as  he  has  received  his  grain. 

Very  little  hay,  if  any,  is  fed  in  the  morning  when  hard  work  follows, 
but  about  one-third  of  the  ration  should  be  fed  at  noon,  and  the  remainder 
at  night.  The  dust  must  be  well  shaken  out  of  the  hay  when  it  is  put  in  the 
mangers. 

In  camp  hay  is  fed  at  the  picket  line  morning,  noon,  and  evening;  on  the 
march,  when  the  horses  are  grazed  during  the  day,  in  the  evening  only. 

The  use  of  bran  once  or  twice  a  week  is  important  for  stable  horses.  In 
spring  or  early  summer  they  should  be  grazed. 

Two  and  a  half  ounces  of  salt  should  be  given  each  week,  preferably  lumps 
of  rock  salt,  secured  in  or  near  the  manger. 

Grazing  should  be  encouraged  at  every  spare  moment,  both  in  camp  and 
at  halts  on  the  march. 

The  daily  allowance  of  oats,  barley,  or  corn  is  12  pounds  to  each  horse  and 
9  pounds  to  each  mule;  that  of  hay,  14  pounds  to  each  animal;  the  allowance 
of  straw  for  bedding  is  100  pounds  a  month  to  each  animal. 

"Watering 

1000.  Horses  must  be  watered  quietly  and  without  confusion ;  the  manner 
in  which  this  duty  is  performed  is  often  a  good  test  of  the  discipline  of  a 
mounted  command. 

Horses  are  to  be  led  or  ridden  to  and  from  water  at  a  walk.  At  the 
drinking  place,  no  horse  should  be  hurried  or  have  his  head  jerked  up  from 
the  water. 

In  the  field  or  on  the  march,  the  watering  is  from  the  most  convenient 
running  water;  in  garrison,  it  is  usually  from  troughs,  which  should  be 
cleaned  each  day.  In  warm  weather,  water  drawn  from  a  cold  well  or 
spring  should  stand  long  enough  for  the  chill  to  pass  off. 

The  horses  are  watered  under  the  immediate  direction  of  the  sergeant, 
but,  if  they  are  liable  to  meet  those  of  other  commands  at  the  watering  place, 
a  commissioned  officer  should  supervise  this  duty. 

Horses  should  be  watered  before  feeding  or  not  until  two  hours  after 
feeding.  Ordinarily,  ithey  should  be  watered  twice  a  day;  in  hot  weather, 
three  times  a  day. 

In  very  cold  weather,  once  a  day,  about  noon,  is  sufficient.  A  horse  will 
rarely  drink  freeb^  very  early  in  the  morning. 

If  a  mounted  command  have  to  march  a  long  distance  without  water, 
so  that  it  will  be  necessary  to  encamp  en  route,  the  animals  are  fed,  but 
denied  water  until  just  before  starting,  when  they  are  permitted  to  drink 
freely.    The    command   marches    in   the    afternoon,    and    does    not    encamp 


RIDING  387 

until  it  has  accomplished  at  least  half  of  the  distance,  and  moves  early  the 
next  morning  to  reach  water. 

Watering  the  horses  on  the  march  depends  in  a  great  measure  upon  the 
facilities  to  be  had.  If  nothing  is  known  as  to  the  country  over  which  the 
day's  march  is  to  be  made,  water  call  should  be  sounded  s'hortly  before 
leaving  camp  and  every  horse  given  an  opportunity  to  drink.  As  many 
animals,  however,  will  not  drink  at  an  early  hour  or  until  after  exercising 
the  horses  should  be  watered  again  at  the  first  opportunity.  On  severe 
marches,  frequent  watering  is  of  great  benefit. 

The  daily  allowance  of  water  for  a  horse  at  rest  is  about  six  gallons; 
when  at  work,  from  eight  to  twelve  gallons;  for  a  man,  one  gallon  for  all 
purposes.  One  gallon  of  fresh  water  weighs  81  pounds,  approximately  one 
pint  to  one  pound. 

General  Rules  for  Stable  Management 

1118.  The  following  general  rules  are  recommended: 

The  stable  sergeant  has  immediate  charge  of  the  police  and  sanitary 
condition  of  the  stable,  picket  line,  etc.,  and  is  the  custodian  of  the  forage 
and  stable  property  generally. 

The  stable  is  to  be  kept  thoroughly  policed,  free  from  smells,  and,  except 
portions  of  stalls  that  horses  can  reach,  should  be  well  limewashed.  There 
must  be  no  accumulation  of  manure  or  foul  litter  inside,  nor  near  the  doors 
or  windows  without.  The  feed  boxes  are  washed  from  time  to  time,  and 
kept  clean.  The  ground  about  the  picket  line  is  swept  daily,  and  all  dung, 
etc.,  carried  to  the  manure  heap. 

Except  at  night,  when  the  horses  are  bedded  down,  no  manure  or  urine 
is  to  remain  in  the  stalls ;  the  stable  police  remove  it  as  it  accumulates. 

If  practicable,  all  woodwork  within  reach  of  the  horses,  and  not  protected 
with  sheet  iron  or  other  metal,  should  be  painted  with  thin  coal  tar  to  pre- 
vent it  being  gnawed.  The  same  precaution  may  be  followed  with  regard 
fo  troughs,  picket  posts,  and  picket  line.  It  should  be  thoroughly  dried 
before  putting  horses  near  it. 

Smoking  in  stables,  or  in  their  immediate  vicinity,  is  prohibited. 

One  or  more  lamps  will  be  hung  in  each  stable  to  burn  during  the  night. 

The  horses  are  stalled  according  to  their  positions  in  the  squads;  their 
places  at  the  picket  line  will  be  in  accordance  with  the  same  rule. 

Over  each  horse's  stall  is  placed  the  name  of  the  horse,  under  that  of  his 
rider. 

Clay  is  the  best  for  earthen  floors.     Gravel,  or  sandy  earth,  is  not  suitable. 

The  sloping  of  the  floor  of  stalls  from  the  manger  to  the  heel  post  is 
injurious  and  uncomfortable  for  the  animal,  making  him  stand  in  an  un- 
natural position,  with  the  forelegs  higher  than  the  hind  ones.  When  the 
earthen  floors  are  level,  the  horse  will  paw  a  hollow  for  his  forefeet  unless 
he  can  elevate  his  hind  quarters  by  backing  out  of  the  stall. 

Whenever  horses  go  out  of  the  stable,  the  windows  of  their  stalls  are  to 
be  kept  open,  unless  necessary  to  exclude  rain  or  snow,  or  when  cold  drafts 
affect  the  animals  in  contiguous  or  opposite  stalls. 


388  RIDING,  PACKING,  AND  DRIVING 

Stable  doors  are  never  closed  in  the  daytime,  except  to  keep  out  wet,  or 
to  exclude  cold  winds  that  blow  on  the  horses.  If  the  doors  be  in  a  single 
piece,  bars  are  put  across  the  doorway;  if  divided  into  upper  and  lower 
halves,  it  will  usually  be  sufficient  to  open  the  upper  part.  At  night,  the 
entrance  to  the  stables  should  be  secured  in  such  manner  as  will  prevent  the 
escape  of  animals. 

When  circumstances  permit,  horses  should  be  turned  loose  in  the  paddock 
during  the  daytime,  or  herded  under  charge  of  a  guard.  When  neither  is 
practicable,  they  should,  except  in  very  cold,  windy  weather,  or  in  very  hot 
weather  where  there  is  no  shade,  stand  most  of  the  day  at  the  picket  line, 
as  they  have  better  air  and  are  less  confined,  while  the  stables  become  drier 
and  more  healthful. 

In  ordinary  climates,  cavalry  stables  must  be  kept  as  cool  as  possible. 
If  the  horses  do  not  stand  directly  in  the  draft,  the  colder  the  stable  the 
less  will  they  suffer  if  called  suddenly  to  take  the  field.  For  the  same  reason, 
horses  should  never  be  blanketed  in  the  stable,  except  during  very  cold 
weather. 

Treatment   and   Care   of   Horses 

1 1 19.  Horses  require  gentle  treatment.  Docile  but  bold  horses  are  apt  to 
retaliate  upon  those  who  abuse  them,  while  persistent  kindness  often  reclaims 
vicious  animals. 

A  horse  must  never  be  kicked  or  struck  upon  or  near  the  head  with  the 
hand,  reins,  or  any  instrument  whatever. 

At  least  two  hours'  exercise  daily  is  necessary  to  the  health  and  good  con- 
dition of  horses ;  they  should  be  marched  a  few  miles  when  cold  weather, 
muddy  ground,  etc.,  prevent  drill. 

Horses'  legs  will  be  hand-rubbed  often,  particularly  after  severe  exercise, 
as  this  removes  enlargements  and  relieves  or  prevents  stiffness. 

In  mild  weather  the  sheath  will  be  washed  occasionally  with  warm  water 
and  castile  soap,  and  then  greased;  in  cold  weather,  w'hen  necessary,  the 
sheath  should  be  greased. 

Horses  used  freely  in  snow  and  slush  must  not  be  placed  in  a  warm  stable 
with  littered  stalls. 


CHAPTER    II 

PACK    SADDLE   AND  PACKING 
THE    MEDICAL  DEPARTMENT    PACK    OUTFIT 

Each 

No.  I.  Pack  frame,  of  metal number. .  i 

No.  2.  Stretches  of  spreaders  for  saddle  pads,  of  corrugated 

metal number.  .         2 

No.  3.  Saddle  pads  do ... .         2 


Fig.  250. —  The  Pack  Saddle  Proper. 

No.  4.  Quarter  straps   number. . 

No.  5  and  6.  Quarter  strap  ring  sets,  complete,  consisting  of 
2  rings  with  leather  union  (5)  and  2  cincha 
straps  (6) sets.... 

No.  7.  Cincha,  horsehair,  double   do.  . .  . 

No.  8.  Accessory  leather  straps number.  . 

(389) 


390  RIDING,  PACKING,  AND  DRIVING 

Each 

No.    9.  Breast  collar  straps number.  .  2 

No.  10.  Breast  collar  body  piece do.  .  .  .  i 

No.  II.  Breast  collar  neck  piece do.  . . .  i 

No.  12.  Breast  collar  choke  strap,, do.  . .  .  i 

No.  13.  Fork  straps  for  turnback do.  .  .  .  2 

No.  14.  Turnback  and  crupper,  complete do ...  .  i 

No.  16.  Breeching  hip  strap do ...  .  i 

No.  16.  Breeching  straps do ...  .  2 

No.  17.  Breeching  body  piece do. . .  .  i 

No.  18.  Thongs,  rawhide do.  .  . .  6 

ACCESSORY   ARTICLES 

No.  19.  Cargo  slings,  webbing,  complete,  with  4  straps 

number.  .  2 
No.  20.  Load  cincha    (belly  piece)    short,   complete,   with  2 

cincha  straps  number.  .  i 

No.  21.  Cupped  blind,  complete,  with  2  thongs do. . . .  1 

No.  22.  Load  cincha  (top  piece)  long,  complete do. . .  .  i 

No.  23.  Cargo  cover,  canvas,  3  by  6  feet,  with   14  rawhide 

thongs number . .  i 

No.  24.  Mantas,  canvas,  6  by  6  feet,  with  20  rawhide  thongs, 

number. .  2 

No.  25.  Bags,  canvas,  complete do. . .  ,  2 

No.  26.  Saddle  blanket    do ... .  i 

METHOD   OF  USING   THE    PACK   OUTFIT 

As  the  pack  outfits  are  issued  from  the  supply  depot,  the  pack 
saddle  proper  is  assembled  as  shown  in  Fig.  250.  The  accessory 
articles  are  loosely  packed  in  the  shipping  box. 

To  use  the  pack  outfit,  the  pack  saddle  proper  is  placed  on  the 
animal  with  a  saddle  blanket  under  it.  The  breast  collar  and 
breeching  are  adjusted  to  the  animal  as  required.  The  saddle  is 
then  firmly  cinched  in  position.  To  prevent  undesirable  moving 
about  on  the  part  of  the  pack  animal  vi^hile  the  saddle  and  load  are 
being  placed  in  position,  it  is  advisable  to  blindfold  the  animal  by 
means  of  the  cupped  blind. 

To  load  the  animal,  the  webbing  slings  are  placed  on  the  ground 
with  the  link  piece  down.     On  them  are  placed  such  articles  as 


PACK  SADDLE  AND  PACKING 


391 


may  be  desired.  Chests,  bedding  rolls,  boxes,  etc.,  are  conveniently- 
carried  in  the  slings ;  dressings,  or  a  number  of  small  pieces  that  are 
likely  to  be  lost,  can  be  put  into  the  canvas  bags  and  then  placed  in 
the  slings.  If  desired,  all  articles  may  be  previously  wrapped  in 
the  canvas  mantas  to  protect  them  from  the  elements.  The  sling  is 
then  securely  fastened  about  the  load  by  means  of  the  leather  straps 
secured  to  its  metal  rings. 

The  load  is  divided  in  such  a  manner  that  each  sling  will  carry 
approximately  the  same  weight. 

•  The  next  step  is  to  place  the  load  on  the  animal.     To  do  this, 
the  loaded  slings  are  raised  from  the  ground  and  supported  on  the 


Fig.  251. —  Accessory  Articles. 

metal  posts  of  the  pack  frame  by  means  of  the  iron  links  on  the 
slingsi  If  possible,  both  sides  should  be  loaded  at  the  same  time 
to  prevent  the  saddle  from  turning  on  the  animal's  back. 

The  load  is  now  protected  by  means  of  the  canvas  cargo  cover, 
which  is  thrown  over  it  and  fastened  by  a  number  of  its  thongs. 
Over  this  is  thrown  the  long  canvas  load  cincha.     By  means  of  the 


392  RIDING,  PACKING,  AND  DRIVING 

short-load  cincha  and  its  straps  (which  pass  under  the  belly  of  the 
animal)  the  load  can  be  securely  fastened  so  that  it  will  not  shift. 

Any  additional  load,  such  as  sacks  of  grain,  etc.,  for  which  there 
is  not  room  in  the  slings,  as  well  as  such  necessary  articles  as  mantas, 
canvas  bags,  etc.,  not  in  use,  are  carried  on  the  animal's  back  between 
the  two  sling  loads,  the  long-load  cincha  holding  them  in  position 
when  tightened. 


CHAPTER   III 

DRIVING 

The  wagons  which  the  hospital  corps  man  may  have  to  drive  and 
care  for  are  the  four-mule  escort  wagon,  the  six-mule  army  wagon, 
and  the  four-mule  ambulance  wagon. 

The  standard  wagon  is  the  four-mule  escort  wagon.  The  load 
should  not  exceed  3,000  pounds  on  good  roads;  for  average  condi- 
tions 2,500  pounds  is  considered  a  fair  load. 

For  the  six-mule  army  wagon  the  load  should  not  exceed  4,000 
pounds  on  good  roads ;   for  average  conditions,  3,500  pounds. 

Wagons  should  always  be  supplied  with  a  spare  pole,  an  axe,  a 
bucket  for  watering  the  animals,  a  hammer,  a  monkey  wrench,  spare 
bolts,  a  candle  lantern,  and  a  box  of  axle  grease. 

The  ambulance  is  a  four-wheeled  vehicle,  ordinarily  drawn  by  two 
animals  in  garrison  and  four  in  the  field.  It  provides  transportation 
for  eight  men  sitting  or  four  recumbent  on  litters,  or  four  sitting  and 
two  recumbent.  It  is  fitted  with  four  removable  seats,  which,  when 
not  used  as  such,  are  hung,  two  against  each  side.  The  arrange- 
ments for  supporting  the  upper  tier  of  litters  (upper  berths)  con- 
sist of  two  litter-supporting  posts  and  four  straps.  The  litter- 
supporting  posts  are  two  uprights,  placed  73  inches  apart.  The  one 
in  front  is  stationary,  being  secured  to  the  roof  and  floor;  the  one 
at  the  rear  is  hinged  at  the  top,  and  when  the  upper  berths  are  not 
to  be  used  it  is  strapped  to  the  roof.  When  the  upper  berths  are 
to  be  used,  it  is  unstrapped  and  swung  into  a  vertical  position, 
when  its  lower  end  is  secured  to  the  floor  by  a  slot  and  bolt. 
Fastened  to  each  of  the  litter  supporting  posts,  27!  inches  from  the 
floor,  is  a  socket  for  the  inside  handles  of  the  litter,  and  opposite 
each  socket,  attached  to  the  side  of  the  ambulance,  is  a  strap  to  hold 
the  outside  handles.     The  floor  is  7^  feet  long  and  4  feet  wide. 

The  art  of  harnessing  and  driving  can  only  be  taught  practically. 
Familiarity  with  the  parts  of  the  harness  (Fig.  252)  and  the 
methods  of  harnessing  and  unharnessing  should  be  imparted  to  the 
whole  class,  and  one  man  should  be  detailed  at  a  time  as  assistant 

(393) 


394  RIDING,  PACKING,  AND  DRIVING 

to  the  ambulance  driver  and  stable  man  in  order  that  he  may  learn 
practically  how  to  care  for  the  animals  and  harness  and  how  to 
drive. 

The  following  course  of  instruction  is  taken  from  the  "  Service 
Manual  for  Sanitary  Troops." 


Fig.  252. —  Harness,  i.  Crown;  2,  check  piece;  3,  front;  4,  4,  blinds;  s,  nose  band;  6, 
bit;  7,  curb;  8,  check;  9,  throatlatch;  10,  rein;  11,  collar;  12,  hame;  13,  hame  link;  14, 
hame  strap;  15,  pole  strap;  16.  martingale;  17,  trace-tug;  18,  trace;  19,  saddle;  20,  terret; 
31,  belly-band;  22,  turn-back;  23,  crupper;  24,  breeching;  25,  hip-strap;  26,  trace  bearer. 

THE  AMBULANCE   DETACHMENT  —  THE  DRIVER 

380.  To  each  driver  are  assigned  four  mules,  a  wheel  pair,  and  a 
lead  pair.  The  mule  on  the  left  side  is  called  the  near  mule  and  the 
other  the  off  mule. 

381.  At  the  discretion  of  the  company  commander,  the  ambulance 
orderly  may  be  placed  in  charge  of  one  pair  of  mules  in  harnessing 
and  unharnessing  and  in  hitching  and  unhitching  at  drill,  and  in 
the  field  when  his  services  are  not  required  by  the  sick. 

DISPOSITION    OF    HARNESS 

382.  In  garrison:  The  harness  is  arranged  on  two  or  four  pegs  in 
the  harness  room.  If  two  pegs  only  are  available,  the  wheel  set  is 
placed  on  one  peg  and  the  lead  set  on  the  other.  When  four  pegs 
are  available,  the  near  harness  of  each  set  is  kept  on  the  left  side  of 
the  off  harness. 

In  the  field:  The  lead  bars  are  placed  under  the  end  of  the  pole, 
and  the  harness  is  hung  over  the  pole.  Care  should  be  taken  to 
keep  the  harness  off  the  ground.  In  bad  weather  it  is  advisable  to 
put  the  harness  inside  the  ambulance. 


DRIVING  395 

TO   HARNESS 

383.  A  pair  of  quiet  mules,  in  a  double  stall,  is  assigned  to  each 
recruit,  who  should  be  supervised  at  first  by  a  competent  man. 
The  instructor  causes  a  pair  to  be  harnessed,  points  out  the  names  of 
the  different  parts  of  the  harness  and  explains  their  uses;  he  then 
causes  the  harness  to  be  taken  off  and  replaced  on  its  pegs. 

The  harness  being  on  the  pegs,  the  instructor  causes  the  recruits 
to  stand  to  heel,  and  commands : 

I.    BY  DETAIL,    2.    HARNESS 

Collar  on:  At  this  command  each  driver  puts  on  and  buckles  the 
collar  of  his  off  mule,  then  that  of  his  near  mule. 

Traces  and  breeching:  Each  driver  takes  the  hames,  traces,  and 
breeching  from  the  peg,  carries  them  on  the  right  arm  and,  approach- 
ing the  proper  mule  from  the  near  side,  gently  places  the  harness 
upon  the  mule's  back.  The  hames  are  put  on  the  collar  and  the 
lower  hame  strap  buckled.  Then  the  saddle  is  buckled  on  the  near 
side,  and  the  straps  which  are  attached  to  either  side  of  the  breech- 
ing are  attached  to  the  ring  in  the  martingale  by  means  of  snaps. 

Bridle:  The  off  mule  is  bridled  first,  then  the  near  mule.  Unless 
instructions  to  the  contrary  are  given,  the  halters  are  removed  be- 
fore bridling.  The  check  rein  is  taken  in  the  right  hand,  the  crown 
in  the  left;  the  mule  is  approached  from  the  near  side.  The  check 
rein  is  slipped  over  his  head  and  allowed  to  rest  on  his  neck.  The 
crownpiece  is  then  taken  with  the  right  hand  and  the  bit  in  the 
left;  the  crown  piece  is  then  brought  in  front  and  slightly  below 
its  proper  position.  The  left  thumb  is  inserted  in  the  side  of  the 
mouth,  above  the  tusk,  the  jaw  pressed  open  and  the  bit  inserted 
by  raising  the  crown  piece.  The  ears  are  then  gently  drawn  under 
the  crown  piece,  beginning  with  the  left  ear.  The  throatlatch  is 
then  secured. 

Couple:  Each  driver  backs  his  pair  out  of  the  stall,  places  them 
side  by  side  facing  the  stable  exit,  and  attaches  the  reins  properly. 

To  harness  without  detail : 

I.    HARNESS 

The  mules  are  harnessed  in  the  manner  described  above,  but  each 
successive  step  is  taken  without  command  as  rapidly  as  possible. 


396  RIDING,  PACKING,  AND  DRIVING 

TO   UNHARNESS 

384.  The  command  is  given : 

I.    BY  DETAIL,    2.    UNHARNESS 

Uncouple:  Each  driver  stands  in  front  of  his  mules,  uncouples  the 
reins,  and  fastens  them  by  looping  them  on  the  near  hame  of  the 
near  harness  and  the  off  hame  of  the  off  harness,  and  tying  them 
with  a  half  hitch,  and  then  leads  the  mules  into  the  stall. 

Unbridle:  He  then  unbridles  the  near  mule,  hanging  the  bridle 
on  the  near  hame,  puts  on  the  halter,  and  fastens  the  chain  to  the 
manger;  the  same  is  done  with  the  off  mule,  hanging  the  bridle  on 
the  off  hame  of  the  off  harness. 

Traces  and  breeching  off:  The  various  parts  of  the  harness  men^ 
tioned  in  traces  and  breeching  are  unfastened  in  reverse  order. 
The  left  hand  is  used  to  place  the  breeching,  saddle,  and  hames  on 
the  right  arm  in  removing  the  harness  from  the  mule.  The  harness 
is  placed  on  its  proper  peg. 

Collar  off:  He  removes  the  collar  of  the  near  mule,  then  that  of 
the  off  mule,  and  hangs  them  up  in  the  same  order,  first  near  collar, 
then  off  collar. 

Harnessing  and  unharnessing  in  the  field  is  executed  as  in  garri- 
son with  such  modifications  as  the  disposition  of  the  harness  re- 
quires. The  mules  are  ordinarily  tied  by  the  halters  to  the  wheels 
of  the  ambulance  while  harnessing  and  unharnessing. 

FITTING   HARNESS 

385.  When  the  recruit  has  become  familiar  with  the  methods  of 
harnessing  and  unharnessing  he  will  be  instructed  in  fitting  harness, 
and  the  importance  thereof  will  be  thoroughly  impressed  on  him. 

The  bridle  is  so  adjusted  that  the  bit  touches,  but  does  not  draw 
up  the  corners  of  the  mouth. 

The  collar  when  adjusted  should  freely  admit  the  hand  between 
the  lower  part  and  the  throat  of  the  animal,  and  the  fingers  between 
the  sides  and  the  neck.  A  short  collar  chokes  an  animal  by  pressing 
upon  the  windpipe;  a  narrow  one  pinches  and  rubs  its  neck,  and  a 
broad  collar  works  about  and  galls  the  shoulders. 

The  breech  strap  should  be  adjusted  so  that  it  will  bear  quickly 
when  the  animal  is  required  to  check  the  momentum  of  the  ambu- 
lance, but  will  not  impede  his   movements   while   in   draft.     This 


DRIVING  397 

adjustment  is  most  important.  It  can  best  be  made  by  observing 
the  animal  in  draft,  and  tightening  the  straps  as  much  as  can  be 
done  without  impeding  the  free  movements  of  the  animal  while  in 
draft. 

The  hip  straps  should  be  of  such  length  that  the  breech  strap  will 
bear  just  below  the  point  of  the  buttocks.  The  lower  the  breech 
strap  is  adjusted,  the  less  does  it  assist  the  animal  in  checking  the 
momentum  of  the  ambulance. 

The  loin  strap  should  be  so  adjusted  that  the  traces,  when  in  draft, 
will  be  straight  and  without  downward  pull  on  the  loops  that  support 
them. 

The  length  of  the  wheel  and  lead  traces  must  depend  in  a  great 
measure  upon  the  size  of  the  animal  and  his  stride.  The  rule  for 
lead  pairs  is  to  allow  but  i  yard  from  the  heads  of  wheel  pair  to 
points  of  buttocks  of  leaders  when  in  draft.  The  wheel  traces  should 
be  so  adjusted  as  to  allow  at  least  14  inches  between  hind  quarters 
and  singletree  when  in  draft.  The  traces  should  be  adjusted  so  that 
the  line  of  traction  will  be  straight  from  the  singletree  to  the  collar. 
This  rule  will  regulate,  in  a  measure,  the  length  of  the  loin  straps, 
and  the  matching  of  animals, 

TO   LEAD   OUT 

386.  To  form  pairs  after  harnessing  the  instructor  indicates  the 
place  of  formation,  and  whether  the  formation  is  to  be  in  line  or  in 
column  of  pairs,  and  commands : 

LEAD   OUT  BY   PAIRS 

387.  The  pairs  are  led  out  by  the  driver,  and  formed  at  the 
designated  place. 

TO    POST  THE   TEAMS    WITH    THEIR   AMBULANCES 

388.  The  teams  are  marched  to  the  park  in  columns  of  teams,  and 
so  directed  as  to  approach  the  flank  and  rear  of  the  ambulance.  As 
the  head  of  the  column  approaches  the  ambulance  the  instructor 
commands : 

TEAMS,   TO   YOUR  POSTS 

Each  team,  as  it  comes  opposite  its  ambulance,  wheels  from  the 
column  and  proceeds  to  its  ambulance;  having  passed  the  end  of 
the  pole  the  driver  causes  the  wheel  pair  to  back  so  that  the  pole  is 


398  RIDING,  PACKING,  AND  DRIVING 

between  the  mules.     The  lead  pair  takes  its  position  immediately 
in  front  of  the  wheel  pair. 

THE   PARK 

389.  Ambulances  are  ordinarily  arranged  in  park  in  order  in  line, 
the  ambulances  being  arranged  from  right  to  left  in  order  of  their 
numbers.  The  interval  between  vehicles  may  be  either  the  normal 
of  12.5  yards,  or  such  interval  as  the  commander  may  direct.  The 
three  escort  wagons  are  parked  on  the  left  in  the  same  formation  as 
the  ambulances,  or  in  a  second  park,  as  may  be  prescribed. 

The  lead  bars  are  used  to  support  the  pole  by  means  of  one  single- 
tree. 

In  garrison  ambulances  are  kept  in  a  shed. 

390.  The  column  of  drivers  is  halted  in  front  of  the  building,  the 
sergeant,  first  class,  gives  the  necessary  directions  for  the  formation 
of  the  park,  and  commands : 

FORM    PARK 

The  drivers  fall  out  and  run  the  ambulances  out  by  hand  and 
form  them  in  park. 

The  ambulances  having  been  formed  in  park,  the  drivers  fall  in 
and  are  marched  to  the  stable  or  picket  line,  commanded  by  the 
sergeant,  first  class. 

TO    HITCH    AND  UNHITCH 

391.  The  brake  is  firmly  set  before  teams  are  hitched  to  an 
ambulance  or  wagon,  and  hitching  is  so  conducted  that  the  mules 
are  kept  under  control;  until  teams  are  well  broken,  this  may 
necessitate  the  assignment  of  the  orderly,  or  of  other  drivers,  to 
assist  the  driver  of  the  team. 

392.  Well-broken  teams  are  hitched  as  follows :  After  lead  and 
wheel  teams  have  been  harnessed,  the  lead  team^s  tied  near  their 
respective  ambulances,  and  the  wheel  teams  placed  in  position  in 
front  of  the  ambulances,  the  pole  between  the  mules  and  each  driver 
at  the  heads  of  his  wheel  team,  the  command  is  given : 

I.   DRIVERS,   2.    HITCH 

The  pole  straps  are  passed  through  the  rings  on  the  chains  at  the 
end  of  the  pole  and  fastened  to  the  rings  on  the  hames ;  the  driver 
passes  behind  the  near  mule  and  attaches  the  near  trace  of  the  off 


DRIVING  399 

mule  and  the  traces  of  the  near  mule.  Going  in  front  of  the  team, 
he  passes  to  the  rear  of  the  off  mule  and  attaches  the  fourth  trace. 
He  then  brings  the  lead  team  into  position,  hooks  the  lead  bar  to 
the  end  of  the  pole,  attaches  traces  as  described  above,  takes  the 
reins,  first  of  the  lead  team  and  then  of  the  wheel  team,  and  mounts 
to  the  right  side  of  the  seat.  The  orderly  mounts  the  seat  from  the 
left  side. 

393.  At  the  command : 

I.   DRIVERS,   2.    UNHITCH 

Each  driver  reverses  the  several  steps  used  in  hitching. 

DRIVING 

394.  Never  pole  too  tightly,  especially  when  the  pole  is  a  heavy 
one,  because  if  the  pole  chains  are  tight  the  weight  of  the  pole  will 
continually  rest  on  the  neck.  On  the  other  hand,  if  the  poling  up 
is  too  loose  the  constant  swaying  will  be  a  source  of  irritation  and 
danger  to  the  team. 

COUPLING   REINS 

395.  The  correct  adjustment  of  the  two  short  inside  reins,  called 
coupling  reins,  requires  great  care.  They  should  be  so  fitted  that 
an  even  pressure  is  brought  to  bear  on  both  sides  of  the  animals' 
mouths,  and  in  such  a  way  also  that  both  animals  shall  go  straight 
and  pull  evenly  on  the  traces.  For  instance,  if  the  near  horse  carries 
his  head  to  the  near  side,  the  coupling  rein  on  the  off  side  should 
be  taken  up,  when  his  head  will  be  straightened. 

Supposing  we  have  two  animals  apparently  well  matched,  but 
that  the  near  one  carries  his  head  rather  out  to  the  front,  and  has  a 
light  mouth,  while  the  off  animal  has  a  hard  mouth  and  carries  his 
head  close  to  his  chest.  Now,  to  get  this  pair  to  pull  equally  on  the 
traces  we  must  have  the  near  animal's  rein  considerably  longer  than 
those  of  the  off  animal.  In  this  case  we  should  begin  by  letting 
out  the  off  side  coupling  rein  and  taking  up  the  near  side  rein  the 
same  number  of  holes. 

The  reins  will  now  be  adjusted  so  as  to  permit  the  near  horse  to 
hold  his  head  well  in  front  of  the  other,  while  the  collars  are  brought 
level. 

The  most  general  fault  is  coupling  up  both  reins  too  tightly,  which 
makes  the  animals  carry  their  heads  in  toward  the  pole,  instead  of 
going  straight,  as  they  should  do.     To  prevent  animals  acquiring 


400  RIDING,  PACKING,  AND  DRIVING 

this  habit,  it  is  a  good  plan  to  change  their  positions  occasionally, 
instead  of  always  driving  them  on  the  same  side  of  the  pole. 

It  is  a  convenient  plan  to  have  more  than  one  hole  in  the  billets 
for  buckling  the  reins  on  the  bits,  so  that  an  animal  can  be  pulled 
back  or  let  out  a  hole  or  two  on  either  side  without  altering  the 
coupling  rein. 

HOLDING   TPIE   REINS 

396.  Place  both  reins  in  the  left  hand,  the  near  rein  over  the 
forefinger  and  the  ofif  rein  under  the  middle  finger.  Thus  you  have 
two  fingers  between  the  reins.  The  reason  for  this  is  that  it  gives 
much  more  scope  for  play  of  the  wrist  on  the  mouths  than  if  you 
have  only  one  finger  between  the  reins.  The  thumb  should  point 
straight  to  the  right  and  the  forefinger  be  held  well  out,  pointing  to 
the  right  rear.  This  will  keep  the  rein  close  up  to  the  knuckle, 
and  the  pair  may  be  easily  moved  across  the  road  by  turning  the 
back  of  hand  up  or  down ;  up  for  left  turn,  down  for  right  turn. 

397.  Sit  firmly  but  comfortably  in  your  seat,  body  erect,  without 
stiffness,  and  elbows  close  to  side.  Do  not  lean  forward.  Now 
take  the  whip  in  the  right  hand,  at  the  place  where  it  balances  com- 
fortably, and  you  are  ready  to  start. 

398.  Bring  the  pair  to  attention  by  feeling  their  mouths  gently, 
and  speak  to  them.  If  they  do  not  respond,  touch  them  gently  with 
the  whip. 

The  moment  they  start  drop  the  hand  slightly;  "jibbing"  is 
often  caused  by  neglect  of  this  precaution. 

399.  The  elbows  should  be  held  close  to  the  sides,  with  the  points 
almost  touching  the  hips. 

The  wrist  should  be  well  bent,  as  by  this  means  the  driver  is 
enabled  to  keep  a  perfectly  steady  bearing  on  the  mouths  without 
any  jerking. 

The  forearms  should  be  horizontal,  and  the  fingers  from  3  to  5 
inches  from  the  center  of  the  body,  with  the  knuckles  to  the  front. 

The  thumb  should  not  be  pressed  down  on  the  rein.  The  fingers 
that  should  grip  the  reins  are  the  three  lower  ones. 

400.  Never  hit  an  animal  while  the  right  hand  is  holding  a  rein, 
because  if  you  try  to  cut  him  when  you  have  the  ofif  rein  in  the  right 
hand  you  must  slack  that  rein  off,  and  the  pair  is  apt  to  dash  to  the 
left. 

401.  Do  not  get  into  the  habit  of  "jabbing"  the  pair  with  the 


DRIVING  401 

bits,  and  do  not  flap  the  reins  on  their  backs  to  start  them  or  make 
them  increase  their  pace. 

Drive  at  a  steady,  even  pace,  as  nothing  tires  a  team  so  much  as 
to  constantly  change  the  rate  of  speed. 

When  it  is  necessary  to  pull  up  in  a  hurry,  the  proper  course  to 
pursue  is  to  catch  hold  of  the  reins  with  the  finger  and  thumb  of  the 
right  hand,  just  behind  the  left,  and  shorten  them  as  much  as  neces- 
sary by  pulling  them  through.  This  is  safer  and  more  business-like 
than  elevating  the  hands,  which  disturbs  the  seat. 

402.  The  driving  gloves  should  be  large  and  very  comfortable. 
They  should  never  be  of  a  size  to  cramp  the  hand  in  the  slightest. 

403.  The  right  hand  is  known  as  the  whip  hand.  It  is  generally 
used  only  for  holding  the  whip,  for  assisting  the  left  hand,  and  for 
shortening  the  reins  by  pulling  them  through  from  behind  the  rein 
hand. 

DRIVING  FOUR-IN-IIAND 

404.  The  driving  of  four  animals  as  they  should  be  driven  is  an 
art  that  can  only  be  learned  by  constant  practice  and  study. 

405.  When  driving,  the  body  should  be  kept  upright  and  square 
to  the  front,  but  all  stiffness  should  be  avoided.  The  driving  seat 
should  be  about  three  or  four  inches  higher  at  the  back  than  in  front, 
so  that  the  driver  can  sit  well  back  in  a  really  comfortable  position. 
The  ankles  and  knees  should  be  just  touching  each  other,  and  the 
arms  close  to  the  sides.  The  forearm  should  be  about  horizontal, 
and  the  left  hand,  as  in  driving  a  pair,  from  four  to  five  inches  from 
the  center  of  the  body,  the  back  of  the  hand  being  turned  toward 
the  front,  but  inclined  a  little  toward  the  team.  The  wrist  should 
be  bent  slightly  toward  the  body,  and  on  no  account  allowed  to 
bend  the  other  way.  This  is  far  the  best  position  for  feeling  the 
mouths,  as  the  wrist  then  acts  like  a  spring,  and  an  even  pressure 
can  be  maintained. 

The  driver  should  on  no  account  be  half  standing,  or  merely  lean- 
ing against  the  seat,  with  unbent  knees,  as,  in  the  event  of  a  wheeler 
falling  or  shying  to  the  side,  he  will  probably  be  jerked  off  the 
wagon. 

THE   REINS 

406.  The  best  way  of  holding  the  reins  is  to  have  the  near  lead 
over  the  left  forefinger,  the  off  lead  between  the  forefinger  and  the 
middle  finger,  the  near  wheel  between  the  same  and  under  the  off 

26 


402  RIDING,  PACKING,  AND  DRIVING 

lead.  The  reins  must  be  gripped  firmly  by  the  three  lower  fingers 
of  the  left  hand.  The  thumb  should  point  to  the  right,  and  the 
forefinger  be  held  well  out.  The  near  lead  rein  should  pass  over  or 
close  to  the  knuckle  of  the  forefinger  and  not  over  the  first  or  second 
joint. 

ADJUSTING   THE   REINS 

407.  All  four  reins  can  be  shortened,  if  much  is  required,  by 
pulling  them  through  from  behind,  but  it  is  generally  quicker  and 
neater  to  hold  the  reins  with  right  hand  two  or  three  inches  in  front 
of  left  (the  little  and  third  fingers  over  the  ofif-side  reins  and  the 
middle  finger  between  the  near-side  reins),  and  then  slide  the  left 
hand  up  to  the  right.  This  movement  is  generally  required  when 
going  down  hill. 

WHEEL   REINS 

408.  It  is  better  to  shorten  these  by  pulling  them  through  from 
behind.  This  is  necessary  when  going  down  hill,  especially  when 
the  wheelers  are  loosely  poled  up,  so  as  to  prevent  the  singletrees 
from  hitting  the  leaders'  hind  legs. 

LEAD  REINS 

409.  In  order  to  shorten  these,  take  out  both  the  leaders  with 
the  right  hand  (the  third  and  little  fingers  over  off,  and  first  or 
middle  finger  over  near  side  rein)  ;  they  then  can  be  passed  back 
to  the  left  hand  the  required  length  by  letting  them  slip  through  the 
right  hand  the  necessary  amount.  To  lengthen  them,  simply  pull 
them  through  from  the  front. 

NEAR   LEAD   REIN 

Either  push  through  from  the  front,  with  the  full  of  the  right  hand 
over  the  rein,  or  take  it  right  out  of  left  hand  and  replace  it  the 
proper  length. 

OFF  LEAD  REIN 

Push  it  through  from  the  front. 

NEAR   WHEEL  REIN 

This  is  the  most  difficult  rein  to  keep  in  its  right  place  and  to 
shorten.  It  is  constantly  slipping  when  the  wheelers  pull.  It  appears 
to  be  the  best  plan  to  pull  it  through  from  behind. 


DRIVING  403 

OFF   WHEEL  REIN 

Push  it  through  from  the  front  with  the  right  hand. 

CROSSING   THE  ROAD 

410.  To  the  left:  Turn  the  left  hand,  knuckles  upwara,  and  pass 
it  across  the  body  from  left  to  right;  the  team  will  incline  to  the  left, 
the  reins  on  that  side  being  shorter. 

To  the  right:  Pass  the  left  hand  down  toward  the  left  hip,  back  of 
the  hand  to  the  front,  with  the  knuckles  of  the  forefinger  downward, 
and  that  of  the  little  finger  uppermost.  This  shortens  the  right  hand 
reins  and  causes  the  team  to  incline  in  that  direction.  The  whip 
can  be  applied  to  the  off  wheeler  in  the  first  instance,  or  to  the  near 
one  in  the  second,  if  they  do  not  cross  rapidly  enough. 

TURNING  TO   THE   LEFT 

411.  With  the  right  hand  seize  the  near  lead  and  wheel  reins 
under  the  lower  fingers ;  then  either  pull  those  reins  up  toward  the 
center  of  the  body,  which  will  shorten  them,  or  allow  the  left  hand 
to  go  slightly  to  the  front,  which  will  slack  off  the  right  reins,  or, 
better  still,  combine  these  motions. 

TURNING   TO   THE   RIGHT 

412.  Take  hold  of  the  ofif  lead  and  wheel  reins  with  the  lower 
fingers  of  the  right  hand  and  treat  them  in  the  same  way  as  in  using 
the  left  reins. 

TO   STEADY   THE  TEAM 

413.  In  order  to  steady  the  animals  or  to  ease  the  left  hand,  the 
right  may  be  placed  in  front  of  the  other  over  all  the  four  reins,  the 
third  and  little  fingers  being  over  the  off  reins  and  the  upper  fingers 
over  only  one  of  the  near  reins. 

THE   WHIP 

414.  The  handle  should  rest  in  the  palm  of  the  right  hand  and  be 
kept  firmly  in  its  place  by  the  action  of  the  thumb  pressing  against 
the  base  of  the  forefinger;  the  lower  fingers  will  then  be  left  free  to 
catch  hold  of  the  reins. 

If,  however,  it  is  necessary  to  pull  the  reins  through  from  behind, 
the  lower  fingers  must  be  tightened  on  the  handle,  so  as  to  allow  the 
thumb  and  forefinger  to  be  used. 


40+  RIDING,  PACKING,  AND  DRIVING 

Hold  the  whip  at  an  angle  of  about  30°  to  the  left  and  about 
40°  upward. 

The  thong  ought  to  have  three  or  four  turns  round  the  handle. 

The  point  of  the  thong  should  be  just  under  the  inside  of  the 
thumb ;  this  will  keep  it  from  slipping.  Hold  the  whip  where  it  will 
balance  comfortably,  the  end  of  handle  under  the  forearm,  the  wrist 
well  bent,  and  the  elbow  close  to  the  side. 

415.  When  the  right  hand  is  on  the  reins  or  using  the  whip,  it 
should  be  kept  close  to  the  left,  the  forearm  being  nearly  horizontal. 
It  can  then  rest  on  the  thigh  and  yet  be  ready  for  any  emergency. 

416.  The  wheelers  should  be  hit  in  front  of  the  saddles,  to  avoid 
making  them  kick.  It  is  no  use  hitting  the  wheelers  if  the  leaders' 
reins  are  too  long.  In  this  case  you  must  first  shorten  up  the 
wheelers'  reins,  and  then  use  the  whip  on  the  leaders ;  otherwise,  as 
soon  as  the  wheelers  have  jumped  into  their  collars,  the  leaders  will 
again  press  forward  and  allow  the  wheelers  to  hang  back  as  before. 

417.  The  proper  hitting  of  the  leaders  with  the  whip  can  only  be 
acquired  by  constant  practice  when  off  the  wagon.  A  good  whip 
can  hit  his  leaders  wherever  Tie  desires  and  without  the  dangerous, 
flail-like  swipes  that  some  teamsters  appear  to  consider  necessary. 

TO   START 

418.  Feel  all  the  animals'  mouths,  and,  if  necessary,  give  them 
the  word  to  go,  dropping  the  hand  to  them  at  once  until  the  vehicle 
is  fairly  ofif.  The  wheelers  ought  to  start  the  wagon,  and  this  can 
be  effected  by  touching  them  with  the  whip,  if  they  require  a  hint. 
It  is  never  safe  to  start  without  having  the  whip  in  the  right  hand, 
ready  for  immediate  use.  The  whip  is  to  the  driver  what  the  leg 
is  to  the  rider,  that  is,  it  keeps  the  team  up  to  their  bits.  As  soon 
as  the  team  is  going  straight,  take  the  right  hand  off  the  reins,  at  the 
same  time  keeping  it  close  by,  ready  for  any  emergency. 

PULLING  UP 

419.  When  you  want  to  pull  up,  shorten  all  the  four  reins  by 
passing  the  left  hand  up  to  the  right,  or  else  by  pulling  all  the  four 
reins  through  from  behind,  as  before  explained;  then,  having  the 
right  forefinger  on  the  near  lead  rein,  the  middle  finger  on  the  near 
wheel,  and  the  lower  fingers  of  the  right  hand  on  the  off  reins,  pull 
both  hands  back  toward  the  body,  and  if  necessary  lean  back  a  little. 


DRIVING  405 

Should  the  team  be  getting  the  better  of  you,  and  you  find  that  you 
can  not  stop  it,  it  will  be  found  a  great  assistance  to  place  the  right 
leg  over  all  the  four  reins,  as  you  may  be  able  to  stop  them  by  the 
extra  power  and  leverage  by  the  position  of  the  leg.  Of  course,  it 
is  understood  the  brake  has  been  applied. 

A   FEW    HINTS 

420.  Always  keep  a  steady  pressure  on  the  reins. 

Never  move  left  hand  from  reins,  even  though  the  right  may  be 
holding  them  in  front,  as  it  is  very  difficult  to  get  the  left  hand 
back  into  its  place  again  with  the  reins  in  the  right  places. 

Lead  reins  should  seldom  be  removed  from  left  hand. 

Grip  the  reins  tightly  with  the  third  and  little  fingers  to  prevent 
their  slipping. 

Alter  position  of  the  bits  if  the  team  pulls  hard. 

See  to  it  that  your  wagon  is  always  well  greased. 

Always  take  a  pull  at  the  team  to  steady  it  just  before  you  arrive  at 
the  crest  of  a  hill,  and  begin  to  descend  slowly,  holding  the  leaders 
steady,  and  with  just  enough  traction  to  keep  their  singletrees  from 
hitting  them. 

In  crossing  ruts  and  turning  corners  be  careful  that  the  leaders 
are  out  of  draft;  otherwise  the  pole  may  be  snapped  off  or  the 
wheelers  pulled  down. 

If,  while  going  down  a  hill,  and  especially  when  near  the  bottom, 
you  find  a  wheeler  slipping  on  his  hocks,  do  not  try  to  pull  him  up, 
but  drop  the  hand  and  allow  the  team  to  go  a  trifle  faster. 

RULES   OF   THE   ROAD 

421,  Always  keep  to  the  right  when  meeting  vehicles. 

On  a  narrow  road  a  loaded  team  has  the  right  of  way,  and  it  should 
be  given  ungrudgingly. 

On  overtaking  a  vehicle,  pull  out  to  the  left  and  pass  it  at  a  steady 
pace  and  without  cracking  your  whip  or  coming  in  too  close. 

When  followed  closely  by  another  vehicle  and  both  are  at  a  good 
pace,  signal  with  your  whip  if  you  are  about  to  slacken  your  gait  or 
change  your  direction. 

When  approaching  a  railroad  crossing,  bring  your  team  to  a  walk ; 
halt  if  necessary,  but  always  look  and  listen. 

Be  courteous  in  observing  the  simple  rules  of  the  road  ;  give  plenty 


406  RIDING,  ]PACKING,  AND  DRIVING 

of  room  to  others,  and  do  not  forget  that  a  smile  or  a  pleasant  laugh 
will  do  more  for  you  than  a  growl  or  a  surly  remark.  Horsemen,  as 
a  rule,  possess  good  dispositions ;  meet  them  at  least  half  way. 

CARE   OF  DRAFT  ANIMALS   IN   THE   FIELD 

363.  Constant  and  intelligent  supervision  of  adjustment  of  the 
bearing  parts  of  harness,  packs,  and  saddles  is  productive  of  better 
results  than  medication  in  keeping  transportation  animals  in  service- 
able condition. 

364.  In  preparing  for  the  field  it  is  well  to  bear  in  mind  that  nearly 
all  animals  in  a  command  lose  flesh  rapidly  for  the  first  ten  days  of  a 
march,  and  that  during  this  period  the  adjustment  of  all  parts  of  the 
harn^ess,  more  especially  the  collars,  should  be  given  close  attention. 

365.  If  the  march  should  happen  to  be  a  continuous  and  a  severe 
one,  it  may  be  noticed  that  about  the  sixteenth  day  draft  animals 
appear  suddenly  to  become  very  lean  in  the  muscles  of  the  shoulders, 
back,  abdomen,  and  croup.  If  a  fair  amount  of  forage  is  available 
they  quickly  improve  to  a  certain  point,  where  they  remain  station- 
ary and  continue  to  do  hard  work  without  noticeable  change  under 
an  intelligent  system  of  watering  and  feeding.  They  are  now  in 
working  condition. 

366.  Water  on  the  march  whenever  a  good  opportunity  to  do  so 
presents  itself,  never  forgetting,  however,  that  a  warm  animal  should 
be  watered  but  sparingly,  and  that  such  a  watered  animal  should 
not  be  allowed  to  remain  stationary  even  for  a  few  minutes,  as  this 
induces  laminitis  (founder),  due  to  contraction  of  the  internal  blood 
vessels  by  the  cold  water  taken  and  the  consequent  increase  of  blood 
pressure  in  the  legs  and  feet,  where  it  can  not,  while  the  animal  is 
inactive,  be  taken  care  of  by  the  system.  Laminitis  (founder)  is 
due  to  congestion  of  the  feet. 

367.  Feeding. —  Soon  after  reaching  camp,  oflfer  a  little  hay. 
Water  before  feeding  grain  when  possible.  Offer  grain  immediately 
after  watering,  and  then  place  before  the  animals  what  remains  of 
the  hay  for  that  day.  The  morning  watering  must  of  necessity  be 
governed  by  circumstances.  If  absolutely  sure  of  water  on  the  road 
say  one  hour  after  breaking  camp,  it  would  be  a  needless  waste  of 
time  and  energy  to  water  immediately  before  or  after  the  morning 
feed  on  the  line. 

368.  Midday  baiting. —  As  little  as  i  pound  of  grain  per  animal, 


DRIVING  407 

taken  from  the  daily  allowance  and  given  in  charge  to  each  driver, 
fed  at  the  noon  halt,  will  have  a  wonderful  effect  for  good  on  the 
animals  of  a  command.  At  this  halt  the  careful  driver  will  add  a 
few  handfuls  of  grass,  and  at  the  same  time  look  over  his  collars  and 
breeching  with  a  view  to  their  readjustment. 

369.  Collars  of  steel  are  preferable  to  leather  for  military  use 
when  properly  adjusted  and  cleaned.  When  improperly  adjusted 
they  are  inferior  to  the  leather  article.  Steel  collars  are  adjusted 
by  means  of  bolts  and  plates.  Leather  collars  by  means  of  top  straps 
and  hames.  When  these  methods  will  not  produce  the  desired  results 
the  use  of  collar  pads  must  be  resorted  to.  Felt  collar  pads  are  not 
desirable,  as  they  soon  become  stiff  and  hard. 

A  collar  should  fit  snugly  to  the  sides  of  the  neck  without  com^ 
pressing  it,  and  its  bearing  surface  should  rest  squarely  on  the  bed  of 
muscles  situated  on  the  front  of  the  shoulder.  When  in  position 
there  should  be  a  space  between  its  lower  part  and  the  windpipe 
sufficiently  large  to  comfortably  admit  the  insertion  of  the  open  hand, 
back  up,  as  far  as  the  wrist. 

All  collars  should  be  furnished  with  a  neck  plate  of  zinc  for  the 
protection  of  the  top  of  the  neck  against  rubbing. 

The  prevent  blistering  of  the  top  of  the  neck  on  hot,  sunny  days  it 
will  be  found  that  a  wet  sponge  or  a  wet  piece  of  folded  gunny  sack, 
properly  secured  to  the  top  of  the  collar  and  wetted  at  intervals,  is 
effective. 

The  bearing  surface  of  steel  collars  should  not  be  scraped  unless 
considered  absolutely  necessary  to  remove  accumulated  dirt  due  to 
negligence.  If  scraped  they  should  be  boned  smooth  and  then 
slightly  oiled.  Leather  collars  may  be  easily  cleaned  with  a  damp 
sponge.  They  should  be  thus  cleaned  each  evening.  A  careful 
man  will  not  let  his  collars  remain  on  the  ground  overnight,  but 
will  hang  them  on  the  pole,  or  put  them  in  some  safe  place  where  he 
will  protect  them  from  the  rain  and  the  dust  of  the  camp. 

370.  Necks  and  shoulders. —  On  arrival  in  camp  let  collars  remain 
in  position  for  about  15  minutes.  Their  weight  on  the  hot,  tender 
skin  affords  sufficient  pressure  to  prevent  the  formation  of  swellings 
so  often  observed  after  the  collar  is  suddenly  removed.  Normal 
circulation  will  establish  itself  gradually  under  collar  pressure  alone 
and  the  skin  of  the  shoulders  and  neck  will  regain  its  tone  and 
elasticity. 


408  RIDING,  PACKING,  AND  DRIVING 

After  removal  of  the  collar,  bathe  the  shoulaer  and  neck  with  clean 
water ;  this  to  remove  sand  and  dust  that  would  otherwise  remain  in 
the  hair,  where  it  may  not  be  reached  with  the  horse  brush. 

Salty  water,  or  a  weak  solution  of  vinegar  in  water,  when  applied 
to  the  shoulders  and  neck,  acts  as  a  tonic  to  the  jaded  skin. 

Animals  with  narrow,  lean  shoulders  should  not  be  placed  in  the 
collar.  For  these,  if  they  must  be  harnessed,  a  breast  strap  (Dutch 
collar)  should  be  used. 

When  putting  on  a  collar,  see  that  the  mane  hangs  naturally 
beneath  the  neck  plate.  If  the  collar  is  a  steel  one,  be  careful  when 
snapping  it  in  place  that  the  skin  of  the  upper  part  of  the  neck  is  not 
pinched  between  the  neck  plate  and  the  collar  itself. 

If  swellings  appear  on  the  shoulders,  use  massage  to  remove  them, 
and  in  addition  apply  a  cold-water  pack  during  the  night;  a  wet 
sack  properly  adjusted  and  held  in  place  will  answer  the  purpose. 
If  a  gall  appears,  do  not  grease  it.  Wash  it  with  water  and  soap,  dry 
thoroughly,  and  apply  a  weak  solution  of  alum  (one-half  ounce  to  a 
pint  of  water)  or  a  solution  of  aloes  in  water  (one-half  ounce  to  the 
pint).  If  the  animal  must  be  worked,  use  a  chambered  (cut-out)  pad 
over  the  spot  to  remove  pressure.  Greasy  ointments  serve  as  a  trap 
for  dust  and  sand. 

371.  Traces. —  Verify  the  length  of  traces  frequently.  Do  not 
depend  on  the  chain  links  as  a  guide  in  hitching.  Leather  traces 
stretch  considerably  in  wet  weather.  A  difference  of  half  an  inch 
in  the  length  of  traces  will  cause  trouble  on  the  shoulder  of  the 
shorter  side.  It  is  also  liable  to  produce  lameness  due  to  irritation 
of  extensor  muscles.  If  the  point  of  attachment  of  the  trace  to  the 
collar  should  be  too  high,  it  will  cause  a  downward  pull  on  top  of 
neck,  with  its  consequent  irritation.  If  too  low,  it  will  cause  the 
collar  to  "  ride,"  and  nearly  all  the  pressure  will  be  on  the  point  of 
the  shoulder  and  on  the  windpipe. 

The  number  of  sore-shouldered  draft  animals  in  a  command  on 
the  march  is  an  excellent  standard  by  which  to  judge  the  horseman- 
ship of  the  personnel. 

372.  Breeching. —  The  breeching  shoula  oe  f ainy  loose,  otherwise 
it  is  liable  to  chafe  the  quarters  and  to  interfere  with  the  free  play 
of  the  muscles.     It  should  be  taken  up  as  the  animals  become  thin. 

Martingales  should  not  fit  too  snugly,  as  they  are  very  liable  to 
chafe  the  soft,  thin  skin  of  the  under  part  of  the  body. 


DRIVING  409 

373.  Yoke  straps  should  be  adjusted  with  a  view  to  the  height  of 
the  pair.  They  should  never  be  permitted  to  trespass  on  the  bearing 
surface  of  the  collars. 

374.  Backstraps  should  be  so  adjusted  as  not  to  let  the  saddles 
ride  the  withers,  but  at  the  same  time  there  should  not  be  sufficient 
strain  on  them  to  cause  the  crupper  to  irritate  the  under  part  of  the 
tail. 

375.  Bellyhands  and  cinchas  should  never  be  unduly  tightened,  as 
they  cause  cinch  sores  near  the  elbow  and  quarterstrap  sores  beneath 
the  ring  shields. 

When  a  cinch  gall  appears,  remove  the  cause,  keep  the  place  clean, 
and  apply  a  solution  of  aloes  or  alum  in  water.  Either  of  these  will 
stimulate  the  gall  and  deter  insects  from  alighting  on  the  wound. 

376.  Bearing  reins  should  be  of  such  a  length  that  the  animals 
may  have  free  use  of  the  muscles  of  head  and  neck.  Bearing  reins 
are  not  a  necessity. 

377.  A  driving  bit  should  be  smooth  and  jointed.  It  should  be  so 
adjusted  that  it  will  not  lift  the  corners  of  the  mouth.  If  placed  too 
high  in  the  mouth,  the  animal  uses  his  molar  teeth  to  press  against 
it,  and  gains  for  himself  the  reputation  of  a  hard-mouthed  puller. 

378.  Beware  of  thread  ends  in  collar  pads  and  of  knots  in  head- 
stalls, throatlatches,  bellybands,  cinchas,  and  surcingles,  and  be  care- 
ful that  buckles  are  not  turned  toward  the  skin.  These  readily  pro- 
duce irritations  and  abrasions,  and  are  plain  evidence  of  negligence 
and  carelessness  on  the  part  of  the  rider  or  driver,  as  well  as  loose 
supervision  on  the  part  of  those  superior  in  rank. 

379.  To  keep  his  animal  in  the  collar  and  off  the  lead  line  should 
be  the  aim  of  each  driver.  This  can  be  accomplished  with  little 
trouble,  barring  accidents,  if  the  harness  is  kept  in  proper  shape  and 
fit  and  necks  and  shoulders  are  kept  clean. 

Wagons  in  the  field  should  be  inspected  at  the  end  of  each  day's 
march,  and,  if  practicable,  all  necessary  repairs  made  promptly. 
Particular  attention  should  be  given  to  discovering  the  loss  of  nuts 
and  to  replace  the  missing;  a  good  supply  of  nuts  and  a  few  extra 
bolts  should  be  carried  in  the  tool  box.  The  axles  should  be  greased 
daily  and  care  taken  to  remove  the  old  before  putting  on  fresh 
grease. 


410  RIDING,  PACKING,  AND  DRIVING 

List  of  articles  carried  on  each  wagon : 

Number 

Axe,  front  of  wagon i 

Axle  nuts,  in  tool  box 2 

Bucket  G.  I.,  under  rear  of  wagon i 

Sponge,  in  tool  box i 

Currycomb  and  brush,  in  tool  box i 

Cases  axle  grease,  in  tool  box 2 

Extra  hames,  in  tool  box 2 

Lantern,  in  water  bucket i 

Wagon  wrench,  in  tool  box i 

Open  links,  in  tool  box 3 

Pole,  on  side  of  wagon i 

Reach,  on  side  of  wagon i 

Pickax,  on  side  of  wagon i 

Three-eighths  or  half-inch  rope,  on  side  of  wagon,  ft 150 

Spade,  on  side  of  wagon .• i 

Hame  straps,  in  tool  box ....    3 

Hame  strings,  in  tool  box. .  .^ * 3 

Shoe  for  each  foot  of  each  animal,  previously  fitted,  in  tool  box.  i 

Horse-shoe  nails,  in  tool  box 

Singletrees,  under  wagon 2 

Doubletree,  under  wagon i 

Ball  strong  twine  for  harness  repairs I 

Harness:  The  harness  should  be  examined  daily,  and  any  defect 
or  weakness  should  be  repaired  at  once.  When  removed  from  the 
animals  at  night,  harness  should  be  placed  where  it  will  dry  and  not 
be  thrown  upon  the  ground.  The  collars  should  be  carefully  wiped 
off  and  the  dirt  removed  from  the  remainder  as  far  as  practicable. 
Harness  should  be  thoroughly  cleaned  at  least  twice  a  month.  For 
this  purpose  use  a  bucket,  lukewarm  water,  sponge,  harness  soap, 
harness  dressing,  neat's  foot  oil,  and  lampblack.  For  ordinary 
cleaning,  the  following  should  be  observed :  Provide  a  rack  to  hang 
the  harness  on.  When  no  better  arrangement  is  at  hand,  insert  one 
end  of  the  wagon  pole  between  the  spokes  of  one  of  the  hind  wheels, 
above  the  hub.  Strap  it  to  the  axle  and  hang  the  harness  on  the 
pole.  Dampen  the  sponge  in  water  and  pass  it  over  the  harness 
until  the  dirt  has  become  soft.     Rinse  out  the  sponge  as  often  as 


DRIVING  411 

necessary,  renewing  the  water  when  it  is  dirty.  Then  rub  the 
sponge  on  the  harness  soap  until  a  good  lather  is  obtained,  and  give 
the  harness  a  good  heavy  coating  of  it,  and  rub  it  until  all  dirt  is 
removed.  Then  work  up  a  thick  soap  lather,  coat  the  leather  part 
of  the  harness  with  it,  and  allow  it  to  dry  without  further  rubbing. 
When  dry,  put  on  a  light  coat  of  harness  dressing  with  a  clean 
sponge,  touch  lightly,  only  enough  to  spread  the  dressing,  and  do 
not  rub.  When  harness  is  dry  and  hard  from  neglect,  after  cleaning 
as  above,  take  a  pint  of  neat's-foot  oil  for  each  single  set  of  harness, 
pour  the  oil  into  a  pan  and  mix  it  with  lampblack  in  proportion  of 
one  teaspoonful  to  each  pint  of  oil.  Stir  this  mixture  until  it  has  a 
glossy  black  appearance.  In  cold  weather  the  oil  should  be  warm. 
Apply  with  a  small  sponge,  rubbing  it  well  in.  When  thoroughly 
dry,  apply  harness  dressing  as  previously  described. 


PART  IX 

AEMY    REGULATIONS 


All  soldiers  are  required  to  be  familiar  with  so  much  of  Army 
Regulations  and  the  Articles  of  War  as  is  contained  in  the  Soldier's 
Handbook. 

The  following  course  is  for  noncommissioned  officers  and  candi- 
dates for  these  grades. 


MEDICAL  DEPARTMENT  —  THE    HOSPITAL   CORPS 

1404.  The  members  of  the  Hospital  Corps  will  be  enlisted  for  and 
permanently  attached  to  the  Medical  Department.  In  time  of  war 
the  corps  will  perform  the  necessary  ambulance  service  under  such 
officers  of  the  Medical  Department  and  assistants  as  may  be  detailed 
for  that  duty. 

1405.  Sergeants,  first  class,  and  sergeants  are  appointed  by  the 
Secretary  of  War  on  the  recommendation  of  the  Surgeon  General, 
after  having  passed  a  satisfactory  examination  as  hereinafter  pre- 
scribed. Corporals,  lance  corporals,  and  privates,  first  class,  upon 
recommendation  of  their  detachment  or  organization  commanders 
are  appointed  (i)  by  the  Surgeon  General,  if  serving  with  troops 
under  the  immediate  supervision  of  the  War  Department;  (2)  by 
the  department  surgeon  or  by  the  division  surgeon  of  a  mobilized 
division,  if  serving  with  departmental  or  divisional  troops.  Acting 
cooks  are  appointed  by  the  commanding  officer  of  a  company  or 
detachment  of  the  Hospital  Corps  in  such  numbers  as  are  allotted 
to  the  company  or  detachment  by  the  Surgeon  General,  or  by  the 
department  or  division  surgeon,  by  authority  of  the  Surgeon 
General. 

Sergeants,  first  class,  and  sergeants  are  given  warrants  signed  by 
the  Surgeon  General.     Corporals  are  given  warrants  signed  by  the 

(413) 


414  ARMY  REGULATIONS 

officer  who  appoints  them.  Ordinarily  a  warrant  issued  to  a  non- 
commissioned officer  of  the  Hospital  Corps  confers  grade  under  all 
assignments ;  but  a  limited  warrant  may  be  issued  conferring  grade 
for  service  only  with  a  field  hospital  company,  ambulance  company, 
or  company  of  instruction  designated  therein.  Upon  relief  from 
assignment  to  such  companies  a  limited  warrant  ceases  and  deter- 
mines, and  the  noncommissioned  officer  holding  the  same  reverts 
to  his  previous  grade  in  the  Hospital  Corps. 

No  person  shall  be  designated  for  examination  for  appointment 
as  sergeant,  first  class,  except  by  written  authority  of  the  Surgeon 
General.  The  candidate  must  have  served  as  a  sergeant  not  less 
than  twelve  months  or  as  a  hospital  steward  of  volunteers  or  have 
acted  in  that  capacity  during  and  since  the  war  with  Spain  for  more 
than  six  months.  No  person  shall  be  designated  for  examination 
for  appointment  as  sergeant  except  by  written  authority  of  the 
Surgeon  General,  if  serving  with  troops  under  the  immediate  super- 
vision of  ^the  War  Department,  or  of  the  department  surgeon,  or 
the  division  surgeon  of  a  mobilized  division,  if  serving  with  depart- 
mental or  divisional  troops.     " 

The  examination  of  a  candidate  for  appointment  as  sergeant,  first 
class,  or  sergeant  will  be  conducted  by  a  board  of  medical  officers 
at  the  station  where  the  candidate  is  serving.  If  the  proper  number 
of  medical  officers  to  constitute  the  board  is  not  available  at  the 
station  of  the  candidate  he  will  be  sent  to  the  nearest  station  where 
a  board  can  be  convened.  When  the  examination  is  for  a  limited 
warrant,  the  commanding  officer  of  the  organization  in  which  the 
candidate  is  to  serve  will  constitute  the  board.  In  all  cases  the  report 
of  the  board  will  be  forwarded  directly  to  the  officer  authorizing 
the  examination. 

The  allowance  of  enlisted  men  of  the  Hospital  Corps  of  each 
grade  as  fixed  by  regulations  and  orders  will  not  be  exceeded,  except 
by  special  authority  of  the  Secretary  of  War.  The  proportion  of 
privates,  first  class,  to  privates  will  not  exceed  two  to  one. 

1406.  A  sergeant  first  class  stationed  at  a  place  where  no  post 
return  is  made  will  make  such  personal  reports  as  the  Surgeon 
General  may  direct. 

1407.  Sergeants  first  class,  though  liable  to  discharge,  will  not  be 
reduced.  Sergeants,  corporals,  lance  corporals,  and  privates  first 
class  may  be  reduced  by  sentence  of  a  court  martial,  by  the  Surgeon 


MEDICAL  DEPARTMENT  ^       415 

General,  by  a  department  surgeon,  or  the  division  surgeon  of  a 
mobilized  division. 

1408.  To  test  the  capacity  of  privates  of  the  Hospital  Corps  for 
the  duties  of  noncommissioned  officers,  the  Surgeon  General  and 
chief  surgeons  may  appoint  lance  corporals,  who  will  be  obeyed 
and  respected  as  corporals;  but  no  detachment  shall  have  more 
lance  corporals  at  a  time  than  enough  to  make  the  proportion  of  all 
noncommissioned  officers  present  for  duty  one  to  four  privates  of 
the  Hospital  Corps.  Lance  corporals  are  on  the  same  footing 
regarding  reduction  as  corporals. 

1409.  The  commander  of  a  field  army,  or  of  a  division  or  brigade 
acting  independently,  is  charged  with  the  full  control  of  the  transfer 
from  the  line,  the  enlistment,  reenlistment,  and  discharge  of  members 
of  the  Hospital  Corps  of  his  command. 

141  o.  Enlistments  for  the  Hospital  Corps  will  be  made  in  the 
grade  of  private.  Sergeants  first  class,  sergeants,  corporals,  lance 
corporals,  and  privates  first  class  may  be  reenlisted  in  their  re- 
spective grades  and  their  warrants  and  appointments  continued  in 
force,  provided  they  reenlist  on  the  day  following  that  of  discharge. 
Each  enlistment  and  continuance  will  be  noted  on  the  warrant  or 
appointment  by  the  surgeon.  Recruiting  officers  at  general  recruit- 
ing stations  may  accept  applicants  for  enlistment  or  reenlistment  in 
the  Hospital  Corps  upon  the  authority  of  the  Surgeon  General  and 
will  be  guided  by  his  instructions  in  making  the  physical  examination 
of  such  applicants.  Applicants  may  be  accepted  with  a  vision  of 
20/70  in  each  eye,  correctible  to  20/40  with  glasses,  provided  that 
no  organic  disease  exists  in  either  eye.  After  enlistments  recruits 
will  be  forwarded  to  such  stations  as  may  have  been  designated  for 
them  by  the  Surgeon  General. 

141 1.  Enlisted  men  of  the  line,  musicians  excepted,  may  be  trans- 
ferred to  the  Hospital  Corps  as  privates  by  the  commander  of  a 
division,  separate  brigade,  or  department,  on  the  application  of  the 
surgeon  of  the  post  or  command,  forwarded  through  military  chan- 
nels. The  application  will  state  the  age,  character,  physical  con- 
dition, and  habits  of  the  soldier,  date  of  expiration  of  current 
enlistment,  and  whether  made  for  an  existing  or  prospective  vacancy. 
If  the  soldier  be  over  forty  years  of  age  his  special  qualifications 
for  transfer  will  be  stated. 

1412.  Married  men  will  not  be  enlisted  as  privates  in  or  trans- 


416  ARMY  REGULATIONS 

ferrcd  to  the  corps,  and  no  sergeant  who  is  married  shall  be  re- 
enlisted  without  special  authority. 

141 3.  Members  of  the  corps  will  not  be  required  to  perform  any 
military  duties  other  than  those  pertaining  to  the  corps.  They  will 
be  instructed  in  such  drills,  both  foot  and  mounted,  as  are  necessary 
for  their  efficiency.  They  will  not  be  required  to  attend  ceremonies, 
except  when  directed  by  the  commanding  officer,  and  will  ordinarily 
be  inspected  and  mustered  at  the  hospital.  The  forms  of  inspection 
will  be  in  accordance  with  the  prescribed  drill  regulations  for  the 
Hospital  Corps. 

1414.  To  meet  the  requirements  of  epidemics  or  other  emergen- 
cies and  to  fill  vacancies,  members  of  the  Hospital  Corps  may  be 
transferred  by  the  department  commander,  the  quota  of  each  post, 
as  prescribed  by  paragraphs  1439  and  1440,  not  being  permanently 
exceeded.     Such  transfers  will  be  reported  to  the  Surgeon  General. 

141 5.  Accounts  of  pay  and  clothing  of  members  of  the  Hospital 
Corps  will  be  kept  by  the  surgeon  under  whose  immediate  direction 
they  are  serving.  All  members  casually  at  a  post,  camp,  or  other 
station,  are  under  the  immediate  orders  of  the  surgeon  except 
prisoners,  who  will,  however,  be  borne  on  the  muster  rolls,  morning 
report,  and  returns  of  the  hospital  corps  detachment.  If  discharged, 
their  final  statements  will  be  prepared  by  the  surgeon. 

1416.  At  every  permanent  military  post  there  will  be  at  least  one 
noncommissioned  officer  of  the  Hospital  Corps,  and  an  additional 
noncommissioned  officer  for  every  additional  four  privates  of  the 
Hospital  Corps. 

1417.  At  every  permanent  military  post  there  will  be  at  least  four 
privates  of  the  Hospital  Corps,  six  privates  when  the  strength  of  the 
garrison  is  200,  and  two  privates  additional  for  every  additional  100 
of  strength.  They  will  be  assigned  to  the  respective  duties  con- 
nected with  the  hospital  service  by  the  surgeon  of  the  post. 

1418.  The  number  of  noncommissioned  officers  and  privates  of 
the  Hospital  Corps  to  be  stationed  at  general  hospitals,  arsenals, 
engineer  stations,  and  independent  posts  will  be  determined  by  the 
Surgeon  General  under  the  direction  of  the  Secretary  of  War. 

1419.  Special  instruction  in  the  methods  of  rendering  first  aid  to 
the  sick  and  wounded  will  be  given  to  all  enlisted  men  of  the  Signal 
Corps  and  of  the  line  of  the  Army  by  their  company  officers  for  at 
least  twelve  hours  in  each  calendar  year. 


MEDICAL  DEPARTMENT  417 

1420.  All  men  of  the  Hospital  Corps  will  be  instructed  under  the 
supervision  of  the  surgeon  of  the  post  in  the  duties  of  litter-bearers 
and  the  methods  of  rendering  first  aid  to  the  sick  and  wounded,  and 
in  the  various  subjects  pertaining  to  the  sanitary  soldier. 

GARRISON    AND   FIELD  SERVICE 

1427.  Ambulances  are  vehicles  provided  for  the  service  of  the 
medical  department.  They  will  be  furnished  and  repaired  by  the 
Quartermaster  Corps.  They  will  be  used  only  for  the  following 
purposes:  The  transportation  of  the  sick  and  wounded  and  the 
absolutely  necessary  nurses  or  attendants  on  duty  therewith,  the 
recreation  of  convalescent  patients;  the  instruction  of  the  Hospital 
Corps  in  the  duties  of  the  ambulance  service,  and  in  the  field  in 
urgent  cases,  for  the  transportation  of  medical  supplies.  All  persons 
are  prohibited  from  using  them,  or  requiring  or  permitting  them  to 
be  used  for  any  other  purpose.  Ambulances  will  always  be  subject 
to  the  call  of  the  surgeon,  in  garrison,  and  of  the  medical  officer  on 
whom  responsibility  for  the  transportation  of  the  sick  devolves,  in 
the  field,  whose  duty  it  shall  be  to  report  to  the  commander  of 
troops  any  violation  of  the  above-mentioned  provisions  governing 
their  use.  When  practicable,  in  garrison,  they  will  be  housed  near 
the  hospital. 

1428.  Ambulances  complete  will  be  issued  and  classed  as  follows: 

1.  For  mobile  army  troops,  to  accompany  troops  in  the  field. 

2.  For  post  purposes  exclusively,  e.  g.,  for  Coast  Artillery  sta- 
tions, recruit  depots,  certain  mobile  army  stations  which  would 
require  ambulance  service  after  withdrawal  of  mobile  army  troops 
therefrom,  military  prisons,  supply  depots,  etc.  Department  com- 
manders will  see  that  such  of  these  posts  as  require  ambulance 
service  are  provided  with  ambulances  which  do  not  belong  to  the 
divisional  or  other  sanitary  trains  of  the  mobile  army. 

3.  For  general  hospitals  and  for  reserve  Supply. 

Ambulances  under  class  i  will  be  furnished  in  numbers  pre- 
scribed for  war  basis  in  Tables  of  Organization ;  under  classes  2 
and  3  the  number  of  ambulances  to  be  supplied  will  be  determined 
by  the  War  Department  on  recommendation  of  the  department  com- 
mander as  regards  class  2,  and  of  the  Surgeon  General,  as  regards 

class  3. 

1429.  At  each  post  one  or  more  privates  of  the  detachment  Hos- 

27 


418  ARMY  REGULATIONS 

pital  Corps  will  be  designated  by  the  surgeon  as  ambulance  driver 
only  for  ambulances  not  belonging  to  organized  ambulance  com- 
panies. In  addition  to  his  other  duties  he  will  care  for  the  ambu- 
lance, its  equipment,  and  harness,  and  see  that  they  are  ready  for 
immediate  use;  and  in  the  field  he  will  care  for  the  animals  also. 
In  garrison,  when  it  is  necessary  to  use  the  ambulance  for  any 
transportation  purposes,  the  commanding  officer,  on  the  application 
of  the  surgeon,  will  see  that  the  requisite  animals  are  provided  by  the 
quartermaster  and  placed  at  the  disposal  of  the  surgeon.  At  sta- 
tions of  organized  ambulance  companies,  class  2  ambulances  may  be 
used  for  garrison  ambulance  service  or  the  ambulance  company  may 
furnish  the  garrison  ambulance  service,  at  the  discrection  of  the  post 
commander. 

1431I.  Transportation  assigned  to  mobile  army  troops  for  sani- 
tary purposes  is  classed  as  follows : 

1.  The  sanitary  combat  train.  (A  pack  mule  to  carry  equipment 
for  the  regimental  aid  station.)  These  pack  mules  are  provided  in 
time  of  peace  and  are  assigned  to  the  organizations  indicated  in  the 
Tables  of  Organization.  They  will  be  placed  at  the  disposition  of 
the  surgeon  when  needed  for  drill  of  the  Hospital  Corps  in  packing, 
and  will  habitually  accompany  the  combat  train  of  the  organizations 
to  which  they  are  assigned,  both  in  peace  and  war. 

2.  Ambulances  of  class   i,  paragraph  1428.     These  are  marked 

with  the  words  "  Sanitary  Train  Division,"  and  with  the 

number  of  the  ambulance  company  to  which  assigned.  Ambulance 
companies  operated  in  peace  are  equipped  with  their  quota  of  ambu- 
lances, and  the  remaining  ambulances  of  the  divisional  sanitary  train 
are  attached  in  time  of  peace  to  combatant  organizations  of  the 
division  by  the  department  commander.  Ambulances  so  attached 
are  available  for.  garrison  service  in  peace  when  required,  as  well  as 
ambulances  of  class  2,  and  will  be  cared  for  by  ambulance  drivers 
designated  by  the  surgeon.  When  the  division  is  assembled,  these 
ambulances  accompany  the  organizations  to  which  attached,  join 
the  companies  to  which  they  are  assigned,  and  complete  the  ambu- 
lance equipment  of  the  sanitary  companies  not  operated  in  time  of 
peace. 

3.  Wagons  pertaining  to  the  divisional  sanitary  train.     These  will 

be  marked  with  the  words  "  Sanitary  Train  Division  "  and 

the  number  of  the  company  to  which  assigned.     Companies  belong- 


MEDICAL  DEPARTMENT  419 

ing  to  the  sanitary  train  which  are  operated  in  peace  are  equipped 
with  their  quota  of  wagons.  In  addition,  wagons  of  the  divisional 
sanitary  train  are  attached  to  combatant  organizations,  as  prescribed 
in  Tables  of  Organization,  for  the  transportation  of  the  camp  in- 
firmary. When  the  division  is  assembled  these  wagons  accompany 
the  organizations  to  which  attached  and  join  the  sanitary  companies 
to  which  assigned. 

1433.  Hospital  Corps  personnel  is  classified  as  follows: 

1.  That  portion  attached  to  combatant  organizations. 

2.  That  portion  assigned  to  units  of  the  divisional  sanitary  train 
and  to  administrative  offices  in  the  field. 

3.  That  portion  assigned  to  the  service  of  the  interior  for  service 
in  war,  which  should  include  only  the  minimum  of  trained  men. 

All  men  of  the  Hospital  Corps  will  be  carried  on  muster  rolls  and 
returns  of  the  Hospital  Corps,  under  "Remarks,"  as  attached  to  a 
definite  combatant  organization,  or  as  belonging  to  a  unit  of  class  2, 
or  to  class  3.  Department  commanders  will  determine,  on  recom- 
mendation of  the  department  surgeon,  the  number  of  men  at  each 
post  or  station  to  be  assigned  to  each  class,  within  the  limits  pre- 
scribed in  Tables  of  Organization,  and  the  individual  men  will  be 
assigned  to  their  respective  classes  and  those  of  class  i  attached  to 
organizations  of  mobile  troops  by  the  post  commander  on  recom- 
mendation of  the  surgeon.  Descriptive  lists  of  men  of  the  Hospital 
Corps  of  classes  i  and  2  will  be  kept  in  duplicate  at  posts,  and  all 
other  papers  required  when  sanitary  personnel  accompanies  troops 
to  which  attached,  will  be  prepared  in  advance  so  far  as  practicable. 
Medical  officers  assigned  to  stations  of  mobile  army  troops,  except 
those  on  duty  with  ambulance  or  field  hospital  companies,  will  be 
similarly  attached  to  organizations  by  the  post  commander  on  recom- 
mendation of  the  surgeon.  Combatant  organizations  will  carry 
attached  sanitary  troops  in  red  ink  on  their  muster  rolls  and  returns. 

1434.  On  the  march  each  medical  officer  will  habitually  be  attended 
by  a  mounted  private  of  the  Hospital  Corps.  Riding  horses  author- 
ized in  Tables  of  Organization  will  not  be  permanently  allowed  and 
assigned  in  time  of  peace  for  Hospital  Corps  men  attached  to  com- 
batant organizations.  When  practicable,  the  Quartermaster  Corps 
will  furnish  horses  for  members  of  the  Hospital  Corps  on  duty  in 
the  field  who  are  authorized  to  be  mounted. 

1437.  No  person,  except  the  proper  medical  officers  or  the  officers, 


420  ARMY  REGULATIONS 

noncommissioned  officers,  and  privates  of  the  ambulance  service, 
or  such  persons  as  may  be  specially  assigned  by  competent  military 
authority  to  duty  therewith,  will  be  permitted  to  take  or  accompany 
sick  or  injured  men  to  the  rear,  either  on  the  march  or  elsewhere. 

1438.  When  members  of  the  hospital  corps  are  detailed  for  ser- 
vice in  the  field  during  Indian  wars,  or  when  left  with  the  sick  or 
wounded  under  circumstances  which  justify  the  expectation  that 
their  rights  under  the  Geneva  Convention  will  not  be  recognized, 
commanding  officers  will  issue  to  members  of  the  Hospital  Corps 
revolvers  or  other  available  firearms. 

^  GENERAL   HOSPITALS 

1439.  General  hospitals  will  be  under  the  exclusive  control  of  the 
Surgeon  General  and  will  be  governed  by  such  regulations  as  the 
Secretary  of  War  may  prescribe.  The  senior  medical  officer  on 
duty  therein  will  command  the  same  and  will  not  be  subject  to  the 
orders  of  local  commanders  other  than  those  of  territorial  depart- 
ments to  whom  specific  delegation  of  authority  may  have  been  made. 
The  commanding  officer  of  a  territorial  department  may  order  to 
any  general  hospital  located  within  the  limits  of  his  department  and 
to  the  General  Hospital  at  Fort  Bayard,  N.  Mex.,  any  cases  of  sick- 
ness and  injury  among  officers  and  enlisted  men  under  his  command ' 
that  are  appropriate  for  treatment  at  such  hospital.  Officers  and 
enlisted  men  on  the  active  list  of  the  Army  who  shall  have  been 
transferred  to  a  general  hospital  for  treatment  only  will,  when  fit 
for  duty,  be  returned  to  their  proper  posts  or  commands  by  the 
commanding  officer  of  the  hospital,  unless  he  shall  have  been  other- 
wise instructed. 

1440.  Hospital  transports,  boats,  and  railway  trains,  after  being 
properly  assigned  as  such,  will  be  exclusively  under  the  control  of 
the  Medical  Department,  and  will  not  be  diverted  from  their  special 
purj>oses  by  orders  of  local  or  department  commanders  or  officers 
of  other  staflf  corps. 

SERVICE   OF    HOSPITALS 

1447.  The  senior  surgeon  is  charged  with  the  management  and 
is  responsible  for  the  condition  of  the  hospital,  which  will  be  at  all 
times  subject  to  inspection  by  the  commanding  officer.     The  senior 


MEDICAL  DEPARTMENT  421 

surgeon  of  the  post  will  inspect  the  hospital  every  morning,  and  on 
Saturday  will  also  inspect  the  detachment  of  the  hospital  corps. 

1450.  Patients  will,  if  possible,  leave  their  arms  and  accouter- 
ments  with  their  companies. 

145 1.  Whenever  a  soldier  is  detached  from  his  company  or  other 
organization  or  station  for  treatment  or  observation  by  and  under 
control  of  officers  of  the  Medical  Department,  his  company  or  other 
immediate  commander  will  send  the  soldier's  descriptive  list  direct 
to  the  medical  officer  in  charge  of  the  hospital  or  other  place  to 
which  the  soldier  is  or  has  been  sent.  If  the  list  is  not  received  by 
such  medical  officer  in  due  time,  he  will  make  a  direct  call  upon  the 
proper  officer  to  furnish  the  list.  If  no  change  occurs  in  the  soldier's 
military  status  or  accounts  while  he  is  under  control  of  the  Medical 
Department,  his  original  descriptive  list  will  be  transmitted  to  the 
several  officers  under  whose  charge  he  comes  in  the  course  of  sub- 
sequent transfers,  should  such  ensue,  from  hospital  to  hospital,  by 
hospital  ships,  hospital  trains,  or  otherwise,  or  when  he  is  sent  to  an 
organization  or  station  for  duty.  In  case  the  soldier  is  returned  or 
sent  to,  or  receives  a  furlough  at  the  expiration  of  which  he  is  to 
return  to  or  join,  a  particular  company  or  other  organization  or 
station,  the  list  will  be  sent  directly  to  the  immediate  commander  of 
such  company  or  other  organization  or  station.  When  an  original 
descriptive  list  is  transmitted  as  hereinbefore  directed,  it  will  be 
transmitted  within,  and  by  successive  indorsements  upon,  a  wrapper 
whereon  each  responsible  officer  will  state  expressly  that  there  has 
been  no  change  in  the  soldier's  military  status  cr  accounts  since  he 
came  under  the  charge  of  that  officer,  will  specify  the  period  covered 
by  that  statement,  and  will  state  what  disposition  was  made  of  the 
soldier.  Each  officer  so  transmitting  a  descriptive  list  will  retain 
a  proper  record  of  his  action. 

If,  however,  changes  occur  in  a  soldier's  military  status  or  ac- 
counts while  he  is  detached  from  his  company  or  other  organi- 
zation or  station  and  is  under  the  control  of  the  Medical  Depart- 
ment, the  responsible  medical  officer  will  at  once  open  a  new  descrip- 
tive list  from  the  data  shown  on  the  old  descriptive  list  received  from 
the  officer  last  previously  responsible  in  the  case,  and  will  make 
such  additional  entries  on  the  new  list  as  the  facts  may  require. 
For  his  own  protection,  the  officer  making  the  new  list  will  retain 
and  file,  with  the  records  of  the  place  at  which  the  new  list  is  made, 


1 


422  ARMY  REGULATIONS 


the  old  list  with  its  wrapper,  if  there  is  any,  bearing  the  indorsements 
of  officers  previously  responsible.  If  subsequent  transfers  of  the 
same  soldier  are  made  before  or  when  he  passes  out  of  the  control 
of  the  Medical  Department,  the  new  list  so  opened  will  be  closed 
by  the  proper  entries  thereon  and  filed  with  the  records  of  the  place 
at  which  it  was  made,  and  a  duplicate  of  the  list  so  filed  will  be 
transmitted  from  each  responsible  officer  to  another  by  wrapper 
indorsement,  ^as  hereinbefore  prescribed,  so  long  as  no  change  in 
the  list  is  required. 

Whenever  a  soldier  detached  from  his  company  or  other  organi- 
zation or  station  and  under  control  of  the  Medical  Department 
passes  out  of  that  control,  his  descriptive  list  (new  or  old,  as  the  case 
may  require  under  the  foregoing  provisions  of  this  paragraph)  will 
be  forwarded  at  once  by  the  responsible  officer  as  follows:  (a)  In 
case  of  discharge,  death,  retirement,  capture,  desertion,  return  to 
duty,  or  upon  receiving  a  furlough  at  the  expiration  of  which  the 
soldier  is  to  return  to  his  company  or  other  organization  or  station, 
or  upon  being  dropped,  to  the  soldier's  company  or  other  immediate 
commander;  (b)  in  case  of  transfer  to  another  company  or  other 
organization  or  station,  the  list  (new  or  old,  as  the  case  requires) 
to  the  immediate  commander  of  the  company  or  other  organization 
or  station  to  which,  and  a  copy  of  the  list,  including  copies  of  any  , 
wrapper  indorsements  pertaining  thereto,  to  the  immediate  com-  \ 
mander  of  the  company  or  other  organization  or  station  from  which, 
the  soldier  is  transferred;  (c)  in  case  of  transfer  to  the  Government  , 
Hospital  for  the  Insane,  to  the  Adjutant  General  of  the  Army.  1 

In  the  cases  of  soldiers  detached  from  their  companies  or  other 
organizations  or  stations  and  under  the  control  of  the  Medical  De- 
partment action  will  be  taken  by  the  proper  medical  officers  as 
follows:  If  a  soldier  is  discovered  to  be  a  deserter  from  the  Navy 
or  Marine  Corps,  paragraph  133  will  be  complied  with;  if  a  soldier 
is  discharged,  final  statements  will  be  furnished  him;  if  a  soldier 
dies,  paragraph  162  will  be  complied  with. 

1452.  Sick  or  wounded  soldiers,  discharged  while  in  hospital,  will 
be  entitled  to  medical  treatment  in  hospital,  and  to  the  usual  ration 
during  disability,  or  for  the  period  considered  proper  for  them  to 
remain  under  treatment,  but  a  discharged  soldier  who  has  left  the 
hospital  will  not  be  readmitted  except  upon  the  written  order  of 
the  commanding  officer. 


MEDICAL  DEPARTMENT  423 

1453.  Recently  discharged  soldiers,  needing  hospital  treatment, 
who  arrive  in  New  York  City,  San  Francisco,  or  other  port  on 
Government  transports,  may  be  sent  to  one  of  the  military  hospitals 
in  the  vicinity,  and  rations  in  kind  drawn  for  them  while  undergoing 
treatment. 

1454.  Tents,  clothing,  hospital  furniture,  and  other  stores  used 
in  the  treatment  of  contagious  diseases,  will  be  disinfected  or  burned 
upon  the  recommendation  and  under  the  supervision  of  a  medical 
officer. 

1455.  The  Secretary  of  War  may,  on  the  recommendation  of  the 
Surgeon  General,  order  gratuitous  issues  of  clothing  to  soldiers  who 
have  had  contagious  diseases,  and  to  hospital  attendants  who  have 
nursed  them,  to  replace  articles  destroyed  by  order  of  the  proper 
medical  officer  to  prevent  contagion. 

1457.  Civilian  employees  at  military  posts,  including  employees  of 
post  exchanges,  may  be  furnished  the  medical  supplies  prescribed  for 
them  by  a  medical  officer  under,  such  regulations  as  the  Surgeon 
General  may  establish  in  accordance  with  law. 

1458.  A  civilian  employee  on  duty  at  a  station  where  other  than 
army  medical  attendance  cannot  be  procured  is  entitled,  when 
necessary,  to  admission  to  hospital. 

1462.  The  surgeon  of  a  post  or  command,  or  the  commanding  offi- 
cer of  a  general  hospital  or  other  sanitary  formation,  will  keep, 
account  for,  and  expend  the  hospital  fund,  according  to  the  instruc- 
tions of  the  Surgeon  General,  exclusively  for  the  benefit  of  the  sick 
in  hospital  and  of  the  enlisted  men  of  the  Hospital  Corps  and  mem- 
bers of  the  Nurse  Corps  on  duty  therein. 

HOSPITAL   BUILDINGS 

1466.  When  alterations  of  or  additions  to  hospitals  are  necessary 
the  surgeon  of  the  post,  after  obtaining  from  the  quartermaster  an 
estimate  of  cost,  will  transmit  plans  and  specifications,  with  proposed 
modifications,  through  military  channels,  to  the  Secretary  of  War. 
Similar  action  will  be  taken  upon  quarters  for  sergeants  first  class. 

1468.  Estimates  for  new  construction,  betterments,  and  repairs 
in  connection  with  hospitals,  Hospital  Corps  sergeants'  quarters, 
and  other  buildings,  structures,  and  systems  payable  from  the  appro- 
priation for  "  Construction  and  repair  of  hospitals  "  or  "  Hospital 
stewards'  quarters"  will  be  prepared  separately,  but  in  the  same 


424  ARMY  REGULATIONS 

manner  and  forwarded  at  the  same  time  as  the  estimates  pertaining 
to  other  appropriations  of  the  Quartermaster's  Corps. 

These  estimates  will  be  prepared  by  the  quartermaster,  to  whom 
the  surgeon  will  furnish  in  writing  a  statement  showing  the  items 
required. 

When  the  work  has  been  completed  the  surgeon  will  report  to 
the  Surgeon  General  whether  or  not  it  was  performed  according 
to  the  estimate  and  will  furnish  to  him  a  statement  showing  the 
material  and  balance  of  allotment  remaining.  Approved  plans  or 
estimates  for  construction  or  repair  will  be  altered  only  by  authority 
of  the  Secretary  of  War. 

SICK    CALL 

1471.  At  sick  call  the  enlisted  men  of  each  company  who  require 
medical  attention  will  be  conducted  to  the  hospital  or  infirmary  by  a 
noncommissioned  officer,  who  will  give  to  the  attending  medical 
officer  the  company  sick-report  book  containing  the  names  of  the 
sick.  The  medical  officer,  after  examination,  will  indicate  in  the 
book,  opposite  their  names,  the  men  who  are  to  be  admitted  to  hos- 
pital and  those  to  be  returned  to  quarters,  what  duties  the  latter  can 
perform,  with  any  other  information  in  regard  to  the  sick  which  he 
may  have  to  communicate  to  the  company  commander.  The  senior 
medical  officer  of  the  command  will  make  a  daily  report  of  the  sick 
and  wounded  to  the  commanding  officer. 

MEDICAL  ATTENDANCE 

1473.  Medical  officers  and  contract  surgeons  on  duty  will  attend 
officers,  enlisted  men,  contract  surgeons,  contract  dental  surgeons, 
members  of  the  Nurse  Corps  (female),  prisoners  of  war  and  other 
persons  in  military  custody  or  confinement,  and  applicants  for  en- 
listment while  held  under  observation;  also,  when  practicable,  the 
families  of  officers  and  enlisted  men;  and  at  stations,  or  in  the  field, 
where  other  medical  attendance  can  not  be  procured,  civilian  em- 
ployees. Medicines  will  be  dispensed  to  all  persons  entitled  to 
medical  attendance,  and  hospital  stores  to  enlisted  men  and  hospital 
matrons,  also  to  officers  at  posts  or  stations  where  they  cannot  be 
procured  by  purchase. 

1474.  Medical  officers  and  contract  surgeons  at  their  stations  will 
furnish  medical   attendance  to  officers   and   enlisted  men   on   the 


MEDICAL  DEPARTMENT  425 

retired  list,  but  they  will  not  be  required  to  leave  their  stations  for 
that  purpose.  Medicines,  dressings,  etc.,  will  be  supplied  to  retired 
officers  and  enlisted  men  from  army  dispensaries  on  medical  officers* 
prescriptions. 

MEDICAL   SUPPLIES 

1487.  The  routine  issue  of  disinfectants  is  prohibited. 

1488.  Damaged  or  unserviceable  medicines,  medical  books,  sur- 
gical or  scientific  instruments  and  appliances,  pertaining  to  the 
Medical  Department,  will  not  be  presented  to  an  inspector  for  con- 
demnation until  authority  for  so  doing  has  been  obtained  from  the 
department  surgeon,  or,  if  with  a  mobilized  division,  from  the 
division  surgeon. 

ARTIFICIAL   LIMBS 

1490.  Every  officer,  enlisted  man,  or  employee  of  the  military 
forces  of  the  United  States  who,  in  the  line  of  duty,  or  through  dis- 
ease contracted  in  service,  shall  have  lost  a  limb,  or  the  use  of  a 
limb,  will  receive  once  every  three  years  an  artificial  limb  or  appli- 
ance, or  commutation  therefor,  if  he  shall  so  elect,  under  such 
regulations  as  the  Surgeon  General  of  the  army  shall  prescribe.  The 
money  value  allowed  as  commutation  is,  for  a  leg,  $75 ;  for  an  arm, 
foot,  and  apparatus  for  resection,  $50. 

1491.  Necessary  transportation,  including  sleeping-car  accommo- 
dations, required  for  travel  to  place  where  artificial  limbs  may  be 
fitted,  will  be  furnished  by  the  Quartermaster's  Department,  the 
cost  to  be  refunded  from  any  money  appropriated  for  the  purchase 
of  artificial  limbs. 


426  GENERAL  MEDICAL  ADMINISTRATION 

MANUAL  FOR  THE   MEDICAL  DEPARTMENT 
Part  I  —  General  Medical  Administration 

ARTICLE    II  —  EDUCATION    AND    TRAINING 

Field  Hospitals  and  Ambulance  Companies 

157.  A  limited  number  of  field  hospitals  and  ambulance  com- 
panies are  maintained  in  time  of  peace  to  provide  trained  organiza- 
tions for  duty  with  the  troops  when  they  are  on  field  service  and  to 
afford  a  means  for  training  officers  and  men  of  the  sanitary  service 
in  the  work  of  the  sanitary  field  organizations.  So  far  as  practi- 
cable men  trained  in  these  organizations  should  constitute  that  por- 
tion of  the  Hospital  Corps  personnel  at  posts  which  is  assigned  to 
units  of  the  divisional  sanitary  train  on  mobilization.  (See  Army 
Regulations:  Hospital  Corps.) 

In  the  training  of  these  organizations  special  attention  should  be 
given  to  those  elements  of  field  work  for  instruction  in  which  only 
limited  facilities  are  afforded  at  posts,  such  as  the  practical  use  of 
the  articles  of  field  equipment,  lines  of  aid,  equitation,  care  of 
animals,  and  use  of  the  pack  saddle. 

158.  The  personnel  of  these  organizations  in  time  of  peace  com- 
prise two  classes:  (i)  A  permanent  cadre,  consisting  of  such  num- 
ber of  noncommissioned  officers  and  men  as  are  deemed  necessary 
to  maintain  continuity  of  policy  and  method  in  instruction  ;  (2)  tem- 
porary personnel  attached  to  these  organizations  for  purposes  of 
instruction. 

(a)  Details  of  organization  of  field  hospitals  and  ambulance  com- 
panies are  given  in  Tables  of  Organization. 

163.  Records  of  class  work  will  be  kept  for  each  individual  in  each 
subject  of  the  course,  preferably  upon  loose  sheets  appropriately 
ruled  or  in  a  blank  book  adapted  to  the  purpose. 

(a)  The  relative  standings  of  men  pursuing  the  same  courses,  as 
determined  by  their  average  monthly  standings,  will  be  published 
monthly  to  their  respective  classes. 

164.  Privates  first  class  and  privates  who  obtain  a  final  mark  of 
.70  per  cent  in  each  subject  of  the  course,  will  be  given  certificates  of 
proficiency  on  Form  60. 

(a)  Any  man  who,  after  two  months'  instruction,  shows  such 


MEDICAL  DEPARTMENT  427 

mental  incapacity  and  inaptitude  as  to  render  his  further  attendance 
on  this  course  of  instruction  useless,  will  be  reported  to  the  Surgeon 
General  for  his  action. 

(b)  Men  who  fail  to  attain  proficiency  in  any  subject  may,  in  the 
discretion  of  the  officer  in  charge  of  instruction,  be  required  to  go 
over  the  subject  again. 

165.  Enlisted  men  of  the  permanent  personnel  who  shall  have 
taken  the  prescribed  course  and  obtained  certificates  of  proficiency 
will  not  ordinarily  be  required  to  take  the  course  again ;  but  should 
it  subsequently  appear  probable  that  any  such  enlisted  man,  having 
a  certificate  of  proficiency,  is  nevertheless  not  proficient  in  one  or 
more  of  the  subjects,  he  may  be  required  to  take  the  course  therein 
once  more.  If  upon  the  second  course  the  soldier  does  not  show 
proficiency,  his  former  certificate  will  be  canceled  by  writing  across 

its  face  the  words :     "  Canceled  for  failure  to  qualify  in  

(nammg  the  subject  or  subjects)  on  second  course, to , 

19  ."  This  notation  will  be  signed  by  the  officer  in  charge  of 
instruction.  Failure  to  qualify  on  such  second  course  will  be 
reported  at  once  to  the  Surgeon  General  with  a  view  to  securing  the 
soldier's  transfer  to  post  duty,  it  being  the  aim  of  the  department  to 
retain  in  the  permanent  personnel  only  such  qualified  men  as  will 
be  a  constant  example  of  efficiency  to  the  men  of  the  temporary 
personnel  attached  for  instruction.  Should,  however,  the  soldier 
taking  such  second  course  in  whole  or  in  part  be  again  found  pro- 
ficient a  new  certificate  of  proficiency  will  not  be  given  him,  but  a 
notation  of  the  facts  will  be  made  in  his  descriptive  list.  A  third 
course  will  be  required  in  no  case.  Lack  of  efficiency  in  practical 
work  after  a  second  course  will  indicate  the  necessity  of  other 
measures  of  discipline. 

DISCIPLINE   AND   DUTIES   OF  THE    SOLDIER 

168.  Instruction  in  discipline  —  including  character,  conduct,  mili- 
tary bearing,  obedience,  and  general  efficiency  —  is  to  be  taken  up  at 
once  when  the  recruit  joins  the  detachment,  and  never  ceases,  being 
given  by  commissioned  and  noncommissioned  officers  in  connection 
with  the  soldier's  daily  round  of  duties  and  continued  as  long  as  he 
remains  in  the  service. 

169.  Instruction  m  the  duties  of  the  soldier  will  cover  the  Articles 
of  War,  the  soldier's  handbook,  the  orders  and  regulations  in  regard 
to  saluting,  the  granting  of  indulgences,  arrest  and  confinement,  the 


428  GENERAL  MEDICAL  ADMINISTRATION 

wearing  of  uniforms,  etc.  Besides  the  few  hours  of  formal  teaching 
provided  for  in  the  first  regular  winter  course  in  garrison  every 
opportunity  should  be  taken  at  all  times  to  impart  information  in 
these  various  subjects. 

BEARER   DRILL   AND   FIELD   WORK 

170.  Instruction  in  drill  and  field  work  will  be  given  throughout 
the  year  for  one  hour  a  week.  All  members  of  the  detachment  will 
attend  it  unless  excused  by  the  surgeon  for  some  special  reason. 

(a)  This  instruction  includes  all  the  subjects  in  Part  I  of  the  Drill 
Regulations  and  Service  Manual  for  Sanitary  Troops  and  all  the 
usual  employments  of  field  work,  especially  — 

Uses  of  the  first-aid  packet. 

Uses  of  other  articles  of  the  individual  equipment  of  the  Hospital 
Corps  soldier. 

First-aid  treatment  of  fractures  in  all  regions  of  the  body. 

The  methods  of  transporting  wounded  in  peace  and  in  war. 

Organization  of  the  ambulance  company.  Work  of  the  ambulance 
company  during  an  action.  Establishment  of  aid  and  dressing  sta- 
tions. Collection,  care,  and  transportation  of  the  wounded  from 
the  firing  line  to  the  field  hospital,  with  the  tagging  of  patients  and 
the  treating  of  them  as  indicated,  using  first-aid  equipment  and 
extemporized  materials. 

Use  and  care  of  articles  of  field  hospital  equipment. 

Pitching  and  striking  tentage  and  packing  field  equipment. 

171.  Full  advantage  should  be  taken  of  the  summer  marching  and 
encampment  of  troops  to  impart  the  above  instruction. 

(a)  Occasionally,  throughout  the  year,  all  available  men  should 
be  taken  out  for  marches  with  and  without  the  litter.  , 

CARE    OF   ANIMALS   AND   EQUITATION 

172.  Men  of  the  Hospital  Corps  will  be  instructed  in  the  care  of 
animals  and  in  equitation  as  prescribed  in  Army  Regulations  and  in 
General  Orders. 

WINTER    COURSES    OF    INSTRUCTION    IN    GARRISON 

173.  The  regular  winter  courses  of  instruction  in  garrison  com- 
prise a  period  of  34  weeks  from  November  i  to  June  30.  Acting 
cooks  will  be  required  to  attend  those  in  cooking  only.     All  the  other 


MEDICAL  DEPARTMENT  429 

men  of  the  detachment  will  take  the  prescribed  courses,  except 
"  qualified  "  men,  men  excused  by  the  Surgeon  General  from  further 
instruction  under  the  provisions  of  paragraph  178a,  and  the  abso- 
lutely necessary  attendants  in  the  hospital,  such  attendants  being 
detailed  as  far  as  practicable  from  the  "  qualified  "  men  and  those 
excused  by  the  Surgeon  General.  Night  nurses,  when  on  duty  all 
night  as  such,  will  be  considered  "  necessary  attendants  "  within  the 
meaning  of  this  paragraph. 

174.  The  winter  courses  are  as  follows : 

Course  No.  1. —  For  privates  first  class  and  privates.  Subjects: 
Duties  of  the  soldier,  hours  8;  anatomy  and  physiology,  hours  16; 
first  aid,  hours  20 ;  nursing,  hours  36 ;  total,  hours  80. 

Course  No.  2. —  For  selected  privates  first  class  and  privates. 
Subjects:  Cooking  and  diet  cooking,  hours  12;  materia  medica  and 
pharmacy,  hours  24;  elementary  hygiene,  hours  8;  clerical  work, 
hours  12 ;  total,  hours  56. 

(a)  The  following  textbooks  will  be  used  for  study  and  refer- 
ence: Mason's  Handbook  for  the  Hospital  Corps;  Drill  Regula- 
tions and  Service  Manual  for  Sanitary  Troops;  Manual  for  the 
Medical  Department;  Army  Regulations. 

175.  Practical  performance  of  the  work  they  are  being  instructed 
in  should  be  required  of  soldiers  pursuing  the  winter  courses.  While 
theoretical  teaching  by  lectures,  demonstrations,  and  recitations  from 
textbooks  has  its  place,  it  should  be  regarded  as  a  secondary  one. 

176.  The  sequence  of  the  subjects  will  be  determined  by  the  de- 
partment surgeon,  who  will  consider  the  climatic  and  other  condi- 
tions in  his  department  in  arranging  the  year's  instruction. 

177.  Each  subject  will  be  finished  before  taking  up  another,  and 
upon  its  conclusion  an  oral  examination  therein  will  be  held  by  the 
instructor,  under  the  direction  of  the  surgeon. 

178.  Records  of  class  work  in  the  winter  courses  will  be  kept  in 
a  blank  book  adapted  to  the  purpose.  Every  soldier  taking  the 
courses  will  be  marked  in  each  subject  thereof  daily. 

(a)  Men  who  obtain  a  final  mark  of  70  per  cent  in  any  subject 
will  be  classed  as  "  quahfied  "  in  that  subject.  Men  who  fail  to 
obtain  70  per  cent  will  be  required  to  take  the  course  the  following 
year.  If  they  again  fail,  their  names  will  be  reported  to  the  Surgeon 
General,  who  may  in  his  discretion  excuse  them  from  subsequent 
courses. 


430  GENERAL  MEDICAL  ADMINISTRATION 

(b)  Men  who  obtain  a  final  mark  of  70  per  cent  in  each  subject 
of  one  or  more  of  the  winter  courses  will  be  given  certificates  of 
proficiency  therein  on  Form  60a. 

179.  Men  who  have  previously  qualified  will  be  examined  at  the 
beginning  of  the  winter  courses  to  ascertain  whether  they  continue 
qualified.  If  a  soldier  is  found  still  proficient  on  such  examination, 
that  fact  will  be  noted  in  his  descriptive  list  and  he  will  be  excused 
from  instruction  in  that  subject;  but  a  new  certificate  of  proficiency 
w^ill  not  be  given  to  him.  If,  however,  he  is  found  deficient  in  any 
subject  or  subjects  he  will  be  required  to  take  the  ensuing  course  of 
garrison  instruction  therein. 

180.  The  aggregate  number  of  hours  of  instruction  in  bearer  drill 
and  field  work,  in  care  of  animals  and  equitation,  and  in  the  regular 
garrison  courses  given  during  the  period  of  a  return  of  the  Hospital 
Corps,  Form  47,  to  each  soldier  carried  thereon,  will  be  noted  in  the 
appropriate  column  opposite  his  name  on  the  return. 

INSTRUCTION   IN   THE   FIELD 

181.  In  the  field  special  attention  should  be  given  to  field  work,  to 
include  the  care  of  animals,  equitation,  use  of  field  appliances,  camp 
sanitation,  establishment  of  lines  of  aid  in  battle,  etc.  In  the  field 
no  limit  is  to  be  placed  on  the  amount  of  time  to  be  devoted  to  this 
instruction. 


ARTICLE    IV  —  HOSPITALS   AND    MEDICAL   ATTENDANCE 

210.  Patients  will  not  be  transferred  from  one  ward  to  another 
without  the  authority  of  the  commanding  officer  of  the  hospital. 
The  transfer  of  a  case  from  one  ward  to  another  will  be  reported  to 
the  office  with  the  next  ward  morning  report  of  the  ward  from  which 
the  case  is  transferred.  All  that  is  necessary  is  to  report  the  patient's 
name,  rank,  company,  and  regiment  or  corps,  and  state  the  fact  that 
he  has  gone  from  one  ward  to  the  other,  designating  them.  No 
special  form  is  provided.  A  memorandum  will  suffice,  or  a  register 
card.  Form  52,  may  be  used.  Upon  the  receipt  at  the  office  of  the 
notice  of  transfer  a  memorandum  thereof  will  be  made  on  the  back 
of  the  register  card,  which  will  thus  always  show  what  ward  the 
patient  is  in. 

211.  To  facilitate  and  assure  the  prompt  and  proper  distribution 


MEDICAL  DEPARTMENT  431 

of  patients,  each  ward  surgeon  will  every  morning,  immediately 
after  his  morning  round  of  the  ward,  forward  to  the  office  a  morn- 
report  of  the  ward  on  Form  72,  which  v/ill  be  accompanied  by 
diagnosis  slips  for  new  admissions,  by  all  change  of  diagnosis  cards, 
by  the  chnical  records  of  all  cases  completed  in  the  ward  or  which 
depart  from  the  ward  otherwise  than  by  transfer  to  another  ward, 
and  by  the  notices  of  cases  transferred  to  other  wards  since  the 
preceding  report.  The  ward  morning  reports,  being  of  no  perma- 
nent value,  may  be  destroyed  after  they  have  served  their  purpose. 

EFFECTS  OF  PATIENTS 

221.  The  commanding  officer  of  the  hospital  is  responsible  that 
due  care  is  observed  in  safeguarding  the  money,  valuables,  clothing, 
and  other  effects  of  patients  admitted  to  hospital.  Money  or  other 
valuables  will  be"  receipted  for  by  the  commanding  officer  or  by  an 
officer  designated  by  him,  and,  when  practicable,  deposited  in  the 
hospital  safe  or  in  a  bank.  Enlisted  men  are  forbidden  to  retain 
money  or  other  valuables  received  from  patients  for  safe-keeping. 

(a)  In  the  presence  of  the  patient,  or  of  another  enlisted  man  in 
case  the  patient  is  unconscious  or  insane,  his  clothing  and  other 
effects  will  be  tagged  (Form  76)  for  identification  and  listed  in 
duplicate  on  the  patient's  property  card  (Form  75).  This  hst  with 
the  effects  will  then  be  sent  to  the  individual  in  charge  of  the  store- 
room for  patient's  effects.  He  will  retain  the  original  list  and  turn 
the  dupUcate  in  to  the  record  office,  or  give  it  to  the  patient  as  the 
regulations  of  the  hospital  may  provide.  In  the  smaller  hospitals 
the  duty  of  caring  for  patients'  effects  as  outlined  above  will  devolve 
upon  the  wardmaster ;  in  general  or  other  large  hospitals  it  will  be 
performed  as  directed  in  paragraph  303. 

222.  The  soiled  clothing  of  patients  will  be  washed,  before  it  is 
put  away,  as  a  part  of  the  hospital  laundry  (par.  267).  When  there 
is  reason  to  suspect  that  the  clothing  is  infected  such  measures  of 
disinfection  as  may  be  necessary  to  protect  the  command  will  be 
taken  and  accounts  for  the  expenses  incident  thereto  will  be  for- 
warded on  Form  330,  W.  D.,  for  settlement,  with  an  explanation  of 
the  circumstances. 

223.  When  the  patient  goes  to  duty,  is  furloughed,  or  is  discharged 
from  the  service,  the  surgeon  will  restore  his  effects  and  take  his 
receipt. 


432  GENERAL  MEDICAL  ADMINISTRATION 

224.  When  the  patient  is  transferred  from  a  hospital  his  effects 
will,  if  he  is  able  to  take  care  of  them,  be  restored  to  him.  When 
he  is  unable  to  take  care  of  them,  they  will  be  intrusted  to  the  rank- 
ing officer  or  soldier  in  whose  charge  the  patient  is  put.  A  list 
of  the  effects  will  be  furnished  to  such  ranking  officer  or  soldier, 
who  will  give  his  receipt  therefor  to  the  transferring  officer.  On 
arrival  at  destination  said  custodian  of  the  effects  in  transit  will 
turn  them  over,  with  the  list,  to  the  commanding  officer  of  the 
receiving  hospital,  and  take  his  receipt  therefor. 

225.  In  the  event  of  the  death  or  desertion  of  enlisted  or  commis- 
sioned patients  or  of  military  prisoners  in  hospital,  their  effects 
will  he  disposed  of  in  accordance  with  the  provisions  of  Army 
Regulations. 

226.  The  effects  of  deceased  civilian  patients,  if  claimed  within  a 
reasonable  time,  will  be  delivered  to  their  legal  representatives.  If 
not  claimed  within  a  reasonable  time,  they  will  be  sold  by  the  hospital 
council  and  the  proceeds  taken  up  and  accounted  for  with  the  hos- 
pital fund.  Should  claim  thereafter  be  made  within  three  years  for 
the  proceeds,  the  same  may  on  the  authority  of  the  Surgeon  General 
be  paid  over  to  the  legal  representatives  of  the  deceased.  A  similar 
procedure  will  be  followed  in  the  case  of  effects  abandoned  by 
civilian  patients  upon  their  departure  from  the  hospital.  Watches, 
trinkets,  personal  papers,  and  keepsakes  of  civilians  will  not  be 
disposed  of  as  long  as  there  is  a  fair  prospect  of  finding  their  right- 
ful owners. 

PUBLIC    PROPERTY   IN   THE   POSSESSION  OF   PATIENTS 

227.  Public  property  brought  into  the  hospital  by  the  patient  will 
also  be  listed  in  duplicate  on  his  property  card.  Form  75.  If  his 
disability  is  so  slight  as  to  require  treatment  for  a  few  days  only, 
the  property  will  be  kept  intact,  tagged,  and  restored  to  him  upon 
his  return  to  duty,  taking  his  receipt  therefor;  otherwise,  it  will, 
if  practicable,  be  turned  over  at  once  to  his  commanding  officer, 
whose  receipt  should  be  obtained.  If  such  transfer  is  not  practicable, 
the  following  action  will  be  had :  ( i )  The  medical  officer  will  take 
up  on  his  return  the  medical  property  in  the  soldier's  possession  and 
forward  his  receipt  therefor  to  the  accountable  officer;  (2)  if  the 
medical  officer  is  accountable  for  quartermaster  or  ordnance  prop- 
erty, he  will  take  up  on  his  quartermaster  or  ordnance  papers  all 


MEDICAL  DEPARTMENT  433 

property  belonging  to  those  departments  brought  in  by  the  patient ; 
otherwise  he  will  transfer  such  property  to  the  nearest  representa- 
tives of  those  departments,  whose  receipts  therefor  should  be  ob- 
tained; (3)  the  patient's  commanding  officer  will  be  immediately 
notified  by  mail  of  the  action  taken  under  (i)  and  (2).  (See  also 
pars.  640  and  649.) 

228.  Hospital  clothing  will  be  worn  by  patients  only  during  their 
stay  in  hospital.  Each  article  will  be  marked  as  hospital  property. 
When  very  sick  soldiers  are  transferred  from  one  hospital  to  another 
the  hospital  clothing  necessary  for  their  comfort  may  be  sent  with 
them,  properly  invoiced,  and  accompanied  by  a  check  list,  giving  the 
names  of  the  men  in  whose  possession  it  is.  Under  the  provisions  of 
this  paragraph,  crutches  and  similar  articles  may,  if  necessary,  be 
similarly  transferred  with  the  patient  from  one  post  or  hospital  to 
another.     (See  pars.  496  et  seq.) 

229.  Upon  the  discharge  from  service  of  men  permanently  dis- 
abled, they  may  retain  the  surgical  appliances  then  in  their  use  which 
are  necessary  for  their  comfort  and  safety,  and  the  accountable 
officer  will  drop  the  same  from  his  next  return  of  medical  property, 
submitting  a  certificate  explaining  the  circumstances  as  a  voucher 
for  so  doing. 

DESTRUCTION   OF   INFECTED    PROPERTY 

230.  Infected  clothing  and  other  articles  which  can  be  immersed 
in  boiling  water,  or  otherwise  disinfected,  without  material  injury, 
should  be  disinfected  and  not  burned.  Articles  destroyed  to  prevent 
contagion  must  be  accounted  for  by  the  affidavit  of  the  officer 
responsible,  setting  forth  fully  the  circumstances  necessitating  such 
destruction.     (See  par.  502.) 

MESS    MANAGEMENT 

231.  The  food  supplies  for  the  hospital  personnel  and  patients 
consist  of  rations  issued  by  the  Quartermaster  Corps,  of  articles  pur- 
chased with  or  derived  from  the  hospital  fund  (see  pars.  248  to 
262),  and  of  products  of  the  hospital  garden. 

235.  Each  ward  surgeon  will,  every  morning,  immediately  after 

the  first  round  of  his  ward,  fill  out  a  diet  card.  Form  73,  covering  the 

diet  requirements  of  his  patients  for  the  ensuing  24  hours.     Bills  of 

fare  for  regular,  light,  and  liquid  diets  should  be  made  OUt  and 

28 


434  GENERAL  MEDICAL  ADMINISTRATION 

posted  in  the  wards  and  kitchens.     Additional  articles  not  included 
in  these  diets  are  to  be  ordered  for  special  cases  only. 

(a)  The  diet  cards  from  the  wards  will  be  sent  promptly  to  the 
hospital  office,  where  the  necessary  card  or  cards  will  be  made  out 
covering  the  meals  of  the  hospital  personnel.  All  the  cards  will 
thereupon  be  turned  over  to  the  noncommissioned  officer  in  charge 
of  the  mess  in  season  for  his  action  toward  the  preparation  of  the 
day's  dinner.  Additional  cards  for  newly  admitted  patients  or  newly 
arrived  personnel  will  be  made  out  promptly  when  necessary  and 
sent  to  the  noncommissioned  officer  in  charge  of  the  mess  without 
delay.  The  diet  cards  may  be  destroyed  after  they  have  served  their 
purpose;  usually  they  will  have  no  value  beyond  the  day  of  their 
date  and  the  following  day. 

236.  Each  hospital  mess  will  be  placed  under  the  immediate  charge 
of  a  competent  noncommissioned  officer. 

(a)  It  will  be  his  duty  to  receive  and  care  for  all  articles  of  food 
for  the  mess,  and  he  will  be  held  responsible  for  their  proper  dis- 
position. He  should  be  provided  with  suitable  apparatus  for  pre- 
serving perishable  foods  and  a  suitable  storeroom  for  the  balance, 
and  should  secure  them  by  proper  locks.  He  will  issue  daily  from 
the  stores  to  the  kitchen  the  articles  required  by  the  diet  cards  and 
will  see  that  the  food  is  cooked  as  indicated  thereon.  He  will  keep 
such  record  of  his  receipts  and  issues  as  the  surgeon  may  prescribe 
according  to  the  needs  of  the  particular  hospital,  no  special  form 
therefor  being  provided.  He  will  be  responsible  for  the  condition 
and  cleanliness  of  the  kitchen  and  cooking  utensils,  and  the  kitchen 
force  will  respect  his  orders  accordingly.  He  will  be  responsible 
also  for  the  cleanliness  and  discipline  of  the  messroom,  the  service 
of  the  meals  therein,  and  the  distribution  of  food  to  wardmasters 
for  patients  unable  to  leave  the  wards ;  and  for  the  cleanliness  of 
the  napery  and  table  utensils  used  in  serving  the  food.  He  will  see 
that  table  clothing  and  utensils  used  for  patients  suffering  from 
infectious  diseases  are  properly  disinfected  before  being  returned  to 
the  storerooms  for  further  use.  He  will  be  provided  with  a  suffi- 
cient number  of  assistants  to  assure  the  prompt  and  efficient  per- 
formance of  these  duties. 

237.  A  mess  account  on  Form  74  will  be  kept  by  the  noncom- 
missioned officer  in  charge.  It  should  be  filed  at  the  end  of  every 
month  with  the  retained  hospital  fund  papers  for  that  month.     In- 


MEDICAL  DEPARTMENT  435 

ordinate  gains  in  the  plus  column  would  indicate  undue  economy  in 
the  diet,  while,  on  the  other  hand,  continual  losses  in  the  minus 
column  would  signify  mismanagement  of  the  hospital  fund  or  im- 
proper care  of  the  food  supplies.  The  commanding  officer  of  the 
hospital  should  inspect  this  record  at  frequent  intervals,  with  a  view 
to  keeping  constantly  informed  in  this  respect. 

(a)  When  there  is  more  than  one  mess,  a  consolidated  mess 
account  on  the  same  form  for  the  entire  hospital  should  be  kept  in 
the  office,  the  noncommissioned  officers  in  charge  of  the  several 
messes  being  required  to  report  daily  the  data  therefor. 

238.  For  methods  of  preparing  food  for  both  sick  and  well,  refer- 
ence should  be  had  to  the  authorized  Handbook  for  the  Hospital 
Corps  and  the  Manual  for  Army  Cooks, 

DISPENSARY    MANAGEMENT 

240.  All  prescriptions  will  be  written  in  the  metric  system.  They 
will  be  placed  on  file  in  three  separate  files,  as  follows:  (i)  Pre- 
scriptions for  alcohol  or  alcoholic  Hquors  and  for  medicines  con- 
taining opium  or  any  of  the  salts,  derivatives,  or  preparations  of 
opium  or  coca  leaves.  (2)  Prescriptions  for  civilians  which  do  not 
include  articles  of  the  preceding  class.  (3)  All  other  prescriptions. 
Prescription  files  will  be  subject  to  inspection  by  inspectors  and  post 
commanders  at  all  times. 

(a)  In  connection  with  file  (i)  a  record  will  be  kept  of  the  dis- 
pensary receipts  and  expenditures  of  each  article  specified  therein. 
Unless  otherwise  authorized  by  the  Surgeon  General,  this  record 
will  be  made  on  blanks  of  Form  17a,  adapted  as  may  be  necessary 
to  the  purpose.  A  separate  slip  will  be  kept  for  each  form  in  which 
the  liquor  or  drug  is  supplied,  as  "  Morphine  sulphas,  powder,"  and 
"  Morphine  sulphas,  lo-mgm.  hypo,  tablets."  The  date  of  receipt 
thereof  from  the  storeroom  will  be  noted  in  the  left-hand  column 
and  the  amount,  in  the  proper  metric  unit,  in  the  debit  column. 
The  expenditures  will  be  noted  by  entering  the  prescription  number 
in  the  left-hand  column  and  the  amount  expended  in  compounding 
the  prescription  in  the  credit  column.  At  least  once  a  month  the 
slips  will  be  balanced  and  the  quantities  remaining  on  hand  will  be 
verified  by  a  medical  officer  and  the  facts  noted  over  his  signature.^ 

241.  Active   poisons,   alcohol,    alcoholic    liquors,    and    all   habit- 
forming  drugs  will  be  kept  under  lock  and  key  in  a  separate  closet. 


436  GENERAL  MEDICAL  ADMINISTRATION 

242.  Civilian  employees  of  the  Army  stationed  at  military  posts 
may  purchase  medical  supplies  when  prescribed  by  a  medical  officer. 

(a)  Medicine  charges  for  employees  not  in  hospital  will  be  as 
follows:  In  ordinary  cases,  25  cents  for  each  prescription;  in  the 
case  of  rare  and  expensive  medicines,  dressings,  appliances,  etc.,  at 
such  increased  rate,  to  be  determined  by  the  surgeon,  as  will  reim- 
burse the  United  States  their  cost. 

(&)  Medicine  charges  for  civilian  employees  in  hospital  are  fixed 
at  25  cents  a  day  in  Army  Regulations. 

HOSPITAL   FUND 

248.  The  hospital  fund  is  derived  — 

(i)  From  commutation  of  rations  of  patients  and  members  of  the 
Nurse  Corps. 

(2)  From  savings  on  rations  of  the  Hospital  Corps. 

(3)  From  dividends  from  post  exchange. 

(4)  From  dividends  from  post  garden. 

(5)  From  money  received  for  the  subsistence  of  officers  and  civil- 
ians treated  in  hospital. 

(6)  From  sales  of  property  purchased  with  hospital  fund  (par. 
259),  or  products  pertaining  to  the  hospital  fund  (vegetables  from 
hospital  garden,  etc.). 

249.  In  addition  to  the  post  exchange  dividends  due  the  hospital 
detachment,  the  exchange  council,  with  the  approval  of  the  com- 
manding officer,  shall  determine  the  amount,  if  any,  to  be  turned 
over  to  the  surgeon  for  the  sick  in  hospital.  (See  Appendix:  Post 
Exchange  Regulations.) 

251.  The  hospital  fund  is  regarded  as  a  company  fund,  and  is 
applicable  generally  to  similar  purposes,  in  the  interest  of  enlisted 
men  of  the  Hospital  Corps,  and  of  the  sick  under  treatment  and 
members  of  the  Nurse  Corps  on  duty  in  military  hospitals. 

254.  The  officer  commanding  the  hospital  will  see  that  due  economy 
in  expending  the  fund  is  observed,  and  that  expenditures  are  not 
made  for  improper  purposes.  Receipts  will  be  taken  for  all  pay- 
ments. 

255.  Gratuities  to  hospital  cooks  and  assistant  cooks  may  be  au- 
thorized by  department  surgeons  or  the  Surgeon  General  when  the 
amount  of  the  hospital  fund  on  hand  justifies  such  expenditure. 

(c)   A  gratuity  of  not  exceeding  $10  a  month  may  be  paid  from 


MEDICAL  DEPARTMENT  437 

the  hospital  fund  to  the  hospital  gardener,  when  authorized  by  the 
department  surgeon  or  the  Surgeon  General. 

(b)  Vouchers  for  gratuities  will  cite  upon  their  face  the  date  and 
source  of  the  authority  for  paying  them. 

ICE    FOR   HOSPITALS 

263.  The  chief  use  of  ice  in  hospitals  is  as  an  article  of  food  or  for 
the  preservation  of  food.  For  such  use  it  should  be  obtained  from 
the  Quartermaster  Corps,  from  the  ice  plant,  if  one  is  available,  as 
provided  in  existing  orders  (see  Appendix:  Ice),  or  as  an  issue 
under  Army  Regulations,  when  authorized;  or  by  purchase  from 
the  hospital  fund.    - 

264.  Ice  required  for  medical  administration  proper,  such  as  for 
ice  baths  of  the  sick,  for  medical  photographic  work,  etc.,  should  be 
procured  from  the  Quartermaster  Corps  ice  machine,  if  one  is  avail- 
able, or  be  obtained  by  purchase  at  the  cost  of  the  medical  and  hos- 
pital appropriation.  Routine  purchases  of  ice  for  medical  purposes 
will  not  be  made  without  the  previous  authority  of  the  Surgeon 
General,  or,  in  the  Philippine  Department,  of  the  department  sur- 
geon. Accounts  for  emergency  purchases  will  invariably  be  accom- 
panied by  a  separate  statement  of  their  necessity.  Accounts  for 
ice  for  medical  work  will  be  stated  on  Form  330  or  Form  330a, 
W.  D.,  will  show  in  the  officer's  certificate  (taking  care  not  to 
encroach  upon  the  approval  space  to  the  right  of  the  $  sign)  or  on 
the  blank  fold  on  the  back  of  the  form,  specifically  what  the  ice  was 
for  —  as,  e.  g.,  for  use  in  the  treatment  of  sick  in  hospital,  for  use 
in  developing  photographic  negatives  for  identification  work,  etc. — 
and  will  be  forwarded,  with  one  invoice  of  articles  purchased,  Form 
12,  to  the  department  surgeon,  or  if  from  a  command  under  the 
immediate  supervision  of  the  War  Department,  to  the  Surgeon 
General,  unless  otherwise  directed  by  him. 

HOSPITAL    MATRON 

265.  Authority  for  the  employment  of  hospital  matrons  is  given 
by  section  1239,  Revised  Statutes.  Their  compensation  of  $10  a 
month  and  a  ration  in  kind  or  by  commutation  is  established  by 
sections  1277  and  1295. 

266.  It  is  the  duty  of  the  hospital  matron  to  mend  and  keep  in 


438  GENERAL  MEDICAL  ADMINISTRATION 

repair  the  table,  hand,  and  operating  linen,  the  bedding  and  the 
hospital  clothing  belonging  to  the  Medical  Department,  including  the 
linen  of  the  dentist's  office,  and  to  do  the  hospital  laundry,  or  so 
much  thereof  as  possible  up  to  a  minimum  of  500  pieces  a  month, 
from  time  to  time,  as  the  same  may  be  required  by  the  surgeon. 

(a)  In  the  case  of  matrons  on  duty  at  the  larger  posts  and  at 
general  hospitals  the  Surgeon  Generalmay  modify  or  waive  so  much 
of  this  provision  as  requires  the  laundering  of  a  minimum  of  500 
pieces  of  hospital  linen  a  month  in  addition  to  all  the  mending. 

267.  The  hospital  laundry  comprises:  First,  the  linen,  clothing, 
and  bedding  belonging  to  the  Medical  Department,  as  above  enu- 
merated; second,  the  washable  clothing  of  patients  admitted  to  hos- 
pital, which  requires  cleansing  before  it  can  be  put  away  (par.  222)  ; 
third,  the  white  coats  and  trousers  of  the  enlisted  attendants  (par. 
47a)  ;  fourth,  the  uniforms  (par.  93)  of  the  Nurse  Corps  soiled 
while  on  public  duty, 

(a)  Soiled  blankets,  spreads,  and  other  heavy  pieces  should  not 
be  allowed  to  accumulate,  but  should  be  washed  a  few  at  a  time  as 
they  become  soiled,  so  as  to  equalize  the  matron's  work, 

268.  The  compensation  of  the  matron  being  fixed  by  law,  no  extra 
compensation  for  performing  any  of  the  duties  incident  to  her  em- 
ployment can  be  allowed,  nor  can  other  persons  be  employed  at  the 
expense  of  the  United  States  to  do  her  work  or  any  part  of  it. 

(a)  Matrons  are  forbidden  to  farm  out  their  work  to  other 
persons, 

(b)  Matrons  are  not  entitled  to  leaves  of  absence  or  to  pay  and 
rations  while  absent  or  while  unable  to  perform  their  duty. 

(c)  Matrons  who  are  unable  or  unwilling  to  meet  these  require- 
ments should  be  discharged. 

269.  When  the  number  of  pieces  to  be  laundered  is  more  than  the 
matron  can  do  (having  in  mind  the  minimum  of  500  pieces  a  month 
above  required)  the  excess  may  be  put  out  under  the  provisions  of 
paragraphs  270  to  278.  When  it  would  be  an  economy  and  advan- 
tage to  put  the  entire  laundry  out  instead  of  the  excess  only,  the 
facts  should  be  reported  to  the  department  surgeon  for  his  informa- 
tion with  a  view  to  obtaining  the  necessary  instructions  and  au- 
thority for  further  action.  For  the  purpose  of  this  report  the 
matron's  total  compensation,  including  pay  and  allowances,  is  re- 


MEDICAL  DEPARTMENT  439 

garded  as  equivalent  to  $18  a  month,  of  which  $3  may  be  taken  as 
for  the  mending,  and  the  balance,  $15,  for  the  laundering. 

LAUNDRY    WORK   NOT  DONE   BY    MATRONS 

270.  The  excess  laundry  at  hospitals  where  there  are  matrons  and 
the  entire  laundry  at  other  hospitals  (except  those  with  laundry 
plants  or  otherwise  provided  for  under  special  instructions  from  the 
Surgeon  General)  may  be  put  out  to  private  laundries.  When  com- 
petition is  not  had  the  responsible  officer  will  ascertain  the  lowest 
prices  current  in  the  vicinity  for  good  hand  or  machine  work  and 
govern  his  action  accordingly. 

271.  Individual  laundrymen  and  laundresses  may  be  employed 
under  this  authority  without  advertising  for  proposals,  provided 
they  do  the  work  in  person,  the  same  being  regarded  as  personal 
services  within  the  meaning  of  section  3709,  Revised  Statutes.  The 
vouchers  will  bear  a  notation  showing  that  the  work  was  done  by 
the  creditor  in  person. 

278.  Vouchers  for  laundry  at  a  hospital  where  there  is  no  matron 
will  contain  in  the  officer's  certificate  the  notation  "  No  matron  at 
post." 

(a)  Vouchers  for  excess  laundry  at  a  hospital  where  there  is  a 
matron  will  be  accompanied  by  a  statement  showing  the  matron's 
name,  the  kind  and  number  of  pieces  laundered  by  her  and  put  to 
hire,  respectively,  during  the  period  covered,  and  by  a  certificate 
that  she  was  unable  to  do  any  of  the  laundry  put  out.  These  will 
be  separate  from  the  vouchers,  which  should  contain  no  reference 
thereto. 

GENERAL  HOSPITALS 

Officer  of  the  Day 

297.  The  officer  of  the  day  will  be  assigned  to  duty  for  a  tour  of 
24  hours,  during  which  he  will  always  be  accessible  for  cases  of 
emergency  and  to  meet  the  requirements  of  the  duties  hereinafter 
stated.  He  will  be  notified  by  the  adjutant  of  his  selection  for  duty 
on  the  day  preceding  that  on  which  his  tour  begins.  He  may  be 
required  to  perform  his  regular  duties  when  they  will  not  conflict 
with  the  performance  of  his  duties  as  officer  of  the  day. 


440  GENERAL  MEDICAL  ADMINISTRATION 

298.  Three  noncommissioned  officers  will  ordinarily  be  detailed 
permanently  as  assistants  to  the  officer  of  the  day,  and  there  will 
be  at  all  times  one  noncommissioned  officer  and  one  private  on  duty 
in  his  office.  The  noncommissioned  officers  will  report  to  the  officer 
of  the  day  at  the  beginning  of  their  respective  tours  of  duty  and 
will  in  no  case  leave  the  office  until  the  arrival  of  their  relief. 

299.  At  an  hour  to  be  designated  in  hospital  orders  the  old  and 
the  new  officers  of  the  day  will  report  to  the  commanding  officer, 
the  old  officer  of  the  day  to  render  his  report,  the  new  officer  of 
the  day  to  receive  such  instructions  as  the  commanding  officer  may 
wish  to  give.  At  the  expiration  of  his  tour  of  duty  the  officer  of 
the  day  will  report  in  writing  to  the  commanding  officer  the  hours 
at  which  the  prescribed  inspections  were  made;  any  breaches  of 
discipline,  infraction  of  the  hospital  rules,  neglects  or  disorders  that 
may  have  occurred  during  his  tour  of  duty ;  and  any  other  occur- 
rences which  should  properly  be  brought  to  the  attention  of  the 
commanding  officer. 

300.  The  officer  of  the  day  will  make  a  general  inspection  of  the 
hospital  at  such  hours  as  the  commanding  officer  may  direct.  Dur- 
ing this  inspection  he  will  note  any  disorder  or  neglect  and,  if  prac- 
ticable, will  immediately  correct  the  same.  He  will  satisfy  himself 
that  the  watchmen  or  guards  are  familiar  with  their  duties  and  are 
performing  them  satisfactorily.  During  his  tour  of  duty  he  will 
inspect  at  least  one  of  the  meals  served  in  each  hospital  mess.  He 
will  receive  the  reports  of  the  roll  calls  required  by  orders.  On  the 
outbreak  of  fire  he  will  assume  charge  until  the  arrival  of  the  fire 
marshal  or  of  the  senior  officer  present  at  the  hospital.  In  the 
absence  of  the  ward  surgeon  he  will  examine  the  body  of  any  patient 
who  may  die  during  his  tour  of  duty  and  order  its  removal  to  the 
morgue,  notifying  the  adjutant  of  his  action. 

301.  The  officer  of  the  day  will  examine  and  admit  all  incoming 
patients.  If  the  officer  of  the  day  is  temporarily  unavailable,  the 
noncommissioned  officer  on  duty  in  the  receiving  office  will  notify 
the  adjutant  of  the  arrival  of  patients,  and  the  adjutant  will  act 
in  his  stead  or  designate  another  officer  to  act  temporarily  as  sub- 
stitute for  the  officer  of  the  day  until  he  is  again  available.  In  no 
case  will  a  patient  be  admitted  and  assigned  to  a  ward  until  he  has 
been  seen  and  examined  by  the  officer  of  the  day  or  some  regularly 
desisrnated  substitute. 


MEDICAL  DEPARTMENT  441 

(a)  If  there  is  any  doubt  as  to  the  ward  to  which  he  should  be 
assigned  the  patient  will  be  held  in  the  receiving  ward  for  disposi- 
tion by  the  chief  of  the  medical  service.  The  officer  of  the  day  will 
receive  money  and  valuables  from  patients  on  admission  and  will 
turn  them  over  to  the  registrar  for  safe  keeping.  An  attendant  from 
the  receiving  office  will  conduct  incoming  patients  to  the  wards  to 
which  they  have  been  assigned,  care  for  their  baggage  and  equip- 
ment, and  turn  over  to  the  wardmaster  the  patient's  admission  slip. 
(See  par.  209.) 

302.  The  noncommissioned  officers  on  duty  with  the  officer  of  the 
day  will  keep  a  card  index  of  patients  in  hospital  and  will  enter 
gains  and  losses  on  the  morning  report  of  sick.     (Form  71.) 

303.  Upon  the  admission  of  a  patient  to  hospital  the  noncommis- 
sioned officer  will  secure  his  effects,  other  than  money  and  valuables, 
list  them  in  duplicate  on  the  patient's  property  card  (Form  75), 
tag  them  for  identification  (Form  76),  and  turn  them  over  to  the 
noncommissioned  officer  in  charge  of  the  store  room  for  patients' 
effects.  The  latter  will  sign  both  lists,  retain  one  of  them  and 
return  the  other,  which  will  be  filed  in  the  registrar's  office.  Upon 
the  departure  of  a  patient  from  hospital  the  wardmaster  will  notify 
the  noncommissioned  officer  on  duty,  who  will  obtain  the  list  of  the 
patient's  effects  from  the  registrar's  office,  and  upon  their  delivery  to 
the  patient  obtain  his  receipt,  which  will  be  returned  to  the  registrar's 
office  for  file.     (See  par.  221.) 

304.  All  public  property  left  by  patients  at  the  hospital  will  be 
turned  over  to  the  quartermaster,  who  will  dispose  of  it  as  indicated 
in  paragraph  227. 

305.  In  time  of  peace  the  noncommissioned  officer  on  duty  will 
have  charge  of  the  Hospital  Corps  men  on  duty  as  watchmen.  He 
will  satisfy  himself  that  they  have  been  properly  instructed  and 
understand  their  orders.  He  will  maintain  quiet  and  order  in  the 
hospital  and  will  notify  the  officer  of  the  day  of  any  unusual 
occurrence. 

306.  In  time  of  peace  the  hospital  will  be  guarded  by  Hospital 
Corps  men  detailed  as  watchmen  under  the  officer  of  the  day  and 
his  noncommissioned  assistants.  In  time  of  war  the  necessaiy 
guard  will  ordinarily  be  performed  by  a  permanent  detail  of  sani- 
tary troops,  and  for  this  purpose  the  Flospital  Corps  personnel  will 
be  increased. 


442  GENERAL  MEDICAL  ADMINISTRATION 

(a)  When  this  detail  from  the  sanitary  troops  is  not  available  the 
necessary  guard  may  be  obtained  on  request  from  the  department 
commander.  When  the  commander  of  such  a  guard  is  a  commis- 
sioned officer  he  will  confer  with  the  commanding  officer  of  the 
hospital  as  to  the  character  of  the  guard  duty  desired  by  the  latter, 
but  will  exercise  no  control  over  the  sanitary  formation.  If  such 
a  guard  is  not  accompanied  by  a  commissioned  officer  it  will  be 
reported  by  the  noncommissioner  officer  in  charge  to  the  command- 
ing officer  of  the  hospital  and  will  be  placed  under  the  immediate 
command  of  the  officer  of  the  day. 


ARTICLE  V  —  DEPARTMENT  LABORATORIES 

Water 

357.  The  specimens  should,  when  practicable,  be  collected  by  a 
medical  officer.  If  the  water  to  be  examined  is  delivered  through 
pipes  or  is  pumped  from  a  well  or  cistern,  the  local  supply  pipe  and 
all  pump  connections  should  be  emptied  by  allowing  the  water  to 
run  for  15  minutes  before  taking  the  samples. 

358.  Bacteriological  examinations. —  Samples  of  water  for  bac- 
teriological examination  should  be  collected  in  bottles  furnished  for 
the  purpose.  Each  bottle  is  sterilized  before  leaving  the  laboratory, 
and  the  glass  stopper  is  protected  by  a  piece  of  heavy  sterili2:ed  mus- 
lin securely  wired  to  the  neck  of  the  bottle.  The  stopper  should  not 
be  removed  until  immediately  before  the  bottle  is  filled. 

(a)  In  taking  specimens  from  a  faucet  or  pump  (after  emptying 
the  supply  pipes  and  connections  conformably  to  par.  357)  a  small, 
gentle  stream  should  be  allowed  to  flow,  the  stopper  taken  out,  the 
bottle  grasped  near  the  bottom,  held  in  an  upright  position,  and  the 
stream  permitted  to  flow  into  the  bottle  until  it  is  filled  to  the 
shoulder.  The  stopper  should  then  be  replaced;  both  it  and  the 
cloth  should  be  secured  by  carrying  the  wire  several  times  around 
the  neck  of  the  bottle  and  twisting  the  ends  tight.  The  stopper  must 
be  handled  only  by  the  square  cloth-covered  top.  The  lip  of  the 
bottle  must  not  be  brought  in  contact  with  the  faucet  or  spout,  nor 
should  the  neck  of  the  bottle  or  naked  part  of  the  stopper  be  per- 
mitted to  come  in  contact  with  any  object  during  the  manipulation. 


MEDICAL  DEPARTMENT  443 

The  projecting  flange  is  designed  to  protect  the  plug  of  the  stopper, 
which  it  will  do  if  the  stopper,  after  withdrawal,  is  held  by  the  top 
in  a  vertical  position.  The  stopper  should  not  be  laid  down  and  the 
cloth  should  not  be  handled  by  the  fingers  except  in  the  act  of  secur- 
ing the  wire  about  it.  When  well  water  is  to  be  examined  the 
bottle  should  be  filled  directly  from  the  bucket  constantly  in  use  for 
drawing  the  water,  and  from  no  other  vessel. 

(b)  On  account  of  the  labor  involved  and  the  possibility  of  error, 
bacteriological  examinations  of  water  collected  in  any  other  than  the 
prescribed  receptacles  will  not  be  made. 

(c)  Each  package  should  be  plainly  marked  to  show  the  source 
from  which  the  sample  is  taken  and  the  date  of  collection. 

(d)  The  case  should  be  marked,  "  Water  for  bacteriological  ex- 
amination," and  it  should  be  forwarded  by  mail  at  the  earHest 
moment.     (See  par.  355a.) 

359.  Chemical  examinations. —  The  quantity  of  water  forwarded 
for  chemical  examination  should  be  not  less  than  3  liters.  The 
receptacles  for  transporting  it  should  be  chemically  clean,  and  all 
vessels  used  in  its  collection  should  be  as  clean  as  it  is  possible  to 
make  them. 

(a)  Glass-stoppered  bottles  of  suitable  size  are  best  adapted  for 
the  preservation  of  a  sample  of  water  in  its  original  condition.  In 
pouring  the  water  into  bottles  it  should  not  come  into  contact  with 
the  hands  of  the  operator  or  with  anything  not  essential  to  the 
operation.  Bottles  should  be  filled  to  within  an  inch  of  the  stop- 
pers; the  stoppers  should  be  carefully  rinsed  and  inserted  and 
secured  with  a  canvas  cover  tied  tightly  around  the  neck  of  the 
bottle.  Sealing  wax  or  similar  material  should  not  be  used  to  secure 
the  stoppers. 

(&)  If  no  proper  receptacles  are  available  at  the  post  or  camp  suit- 
able bottles  may  be  obtained  upon  application  to  the  officer  to  whom 
the  specimens  are  to  be  sent  for  analysis.  Bottles  so  obtained  should 
when  filled  be  repacked  in  the  box  in  which  they  came,  reversing  the 
cover,  which  should  have  the  laboratory  address  thereon.  The 
package  should  be  tagged  or  labeled  to  show  the  place  and  date  of 
collection. 

(c)  Water  for  chemical  analysis  should  be  shipped,  immediately 
after  its  collection,  by  express.     A  Medical  Department  bill  of  lad- 


444  GENERAL  MEDICAL  ADMINISTRATION 

ing  will  be  made  for  each  such  shipment  and  the  carrier's  signature 
taken  thereto  upon  turning  over  the  package  for  transportation. 

Until  a  special  form  shall  have  been  provided  therefor  Form  153, 
Q.  M.  C,  may  be  adapted  to  the  purpose  by  altering  the  symbol 
"  W.  Q."  in  the  upper  right-hand  corner  to  read  "  W.  Medical," 
followed  by  the  number  of  the  bill.  The  consignor  should  in  every 
case  fill  out  the  instructions  for  billing  at  the  foot  of  the  bill  of 
lading,  specifying  therein  that  the  freight  charges  are  to  be  vouched 
to  the  Surgeon  General,  Washington,  D.  C.,  and  should  immediately 
mail  the  bill  to  the  consignee,  who  will  upon  receipt  of  the  articles 
accomplish  the  bill  and  surrender  it  to  the  carrier.  The  consignor 
should  at  the  time  of  shipment  furnish  the  carrier  with  a  shipping 
order  (Form  156,  Q.  M.  C),  and  mail  a  memorandum  of  the  bill  of 
lading  (Form  154,  Q.  M.  C.)  to  the  Surgeon  General,  with  infor- 
mation as  to  the  purpose  of  the  shipment  unless  the  same  is  clearly 
revealed  by  entries  on  the  bill. 


ABTICLE  VIII  —  HECORDS,  REPORTS  AND  RETURNS  —  REGIS- 
TER AND  REPORT   OP  SICK  AND  WOUNDED 

The  Register 

42y.  A  full  record  of  the  sick  and  wounded  of  every  military  post 
or  station  and  separate  command  which  is  attended  by  a  medical 
officer  or  private  physician  will  be  made  on  register  cards.  Form  52 ; 
but  this  requirement  will  not  be  applicable  in  time  of  war  to  troops 
or  commands  in  the  theater  of  operations,  except  camp  hospitals  (or 
field  hospitals  acting  as  such),  evacuation  hospitals,  base  hospitals 
and  other  immobile  sanitary  formations  on  the  line  of  communica- 
tions. (See  pars.  575  to  582.)  These  cards  collectively  constitute 
the  register  of  patients,  and  a  case  carded  on  them  is  said  to  be  on 
the  register. 

(a)  The  commanding  officer  will  provide  the  surgeon  with  any 
information  the  latter  may  not  have  which  is  necessary  for  preparing 
and  completing  the  register. 

428.  A  register  card  will  be  made : 

(a)  For  every  person  admitted  to  the  hospital  for  treatment. 

(b)  For  every  officer  and  enlisted  man  with  the  command,  includ- 
ing retired  officers  and  soldiers  under  assignment  to  active  duty, 


MEDICAL  DEPARTMENT  445 

who,  though  not  admitted  to  the  hpspitai,  is  excused  on  account  of 
sickness  or  injury  from  the  performance  of  his  military  duty,  or  of 
some  part  of  it,  such  as  attendance  on  certain  calls,  drills,  target 
practice,  mounted  duty,  etc. 

(c)  For  every  officer  and  enlisted  man  with  the  command  who, 
though  not  excused  from  duty,  is  prescribed  for  or  treated,  or  placed 
under  observation  with  a  view  to  treatment  or,  in  the  case  of  an 
enlisted  man,  to  discharge  on  account  of  disability,  if  his  disability  is 
of  such  a  character  as  to  have  a  probable  bearing  on  his  subsequent 
medical  history :  Provided,  That  a  case  once  carded  for  record  only 
under  this  provision  will  not  again  be  carded  for  record  only  on  the 
same  register  except  when  necessary  to  comply  with  the  provisions 
of  sections  (d),  (e),  (/),  and  (h)  of  this  paragraph.  For  example, 
every  case  of  venereal  disease  or  insanity,  or  suspected  venereal 
disease  or  insanity,  which  comes  under  observation  or  treatment, 
will,  unless  previously  on  the  register  or  otherwise  required  to  be 
registered,  be  carded  for  record  only  under  this  provision, 

(d)  For  every  officer  and  enlisted  man  with  the  command,  not 
currently  on  the  register,  who  is  retired  or  discharged  for  disability, 
or  dies. 

(e)  For  every  officer  ana  enlisteu  man  with  the  command,  not 
currently  on  the  register,  who  is  sent  to  another  station  or  command 
for  observation  or  treatment. 

(/)  For  every  officer  with  the  command,  not  currently  on  the 
register,  who  departs  from  the  command  on  sick  leave. 

(g)  For  every  officer  and  enlisted  man  whose  case  is  received  by 
transfer  conformably  to  the  provisions  of  paragraphs  214  to  217. 

(h)  For  every  retired  officer,  retired  soldier,  former  officer,  or 
former  soldier  with  the  command  but  not  in  the  hospital  who  dies. 

429.  Except  as  required  by  paragraph  428  a  case  prescribed  for 
but  not  admitted  to  hospital  or  excused  from  duty  will  not  be 
registered. 

430.  Cases  under  treatment  by  the  dentist  will  be  entered  on  the 
register  of  sick  and  wounded  only  when  such  entry  is  required  by 
the  provisions  of  paragraph  428. 

431.  When  an  officer  or  soldier  sick  in  hospital  is  retired  from 
active  service,  wholly  retired  from  service,  dismissed,  or  discharged, 
his  case  as  an  officer  or  soldier  will  be  closed  (par.  450)  and  a  new 


446  GENERAL  MEDICAL  ADMINISTRATION 

card  made  for  it  covering  his  continuance  in  hospital  under  his  new 
status. 

(a)  If  an  appHcant  for  enlistment  sick  in  hospital  is  sworn  in  as  a 
soldier,  his  case  as  a  civilian  will  be  closed  and  a  new  card  made  for 
his  case  as  a  soldier. 

(b)  Appropriate  cross  references  from  the  old  to  the  new  cards, 
and  vice  versa,  will  be  made  in  these  cases. 

432.  The  register  cards  will  be  made  day  by  day  as  the  cases  are 
taken  up.  (See  pars.  208a  and  209.)  They  will  be  kept  in  two 
files,  the  current  file  and  the  permanent  file. 

(a)  The  current  file  will  consist  of  the  register  cards  of  uncom- 
pleted cases  arranged  in  dictionary  order  according  to  the  surnames 
of  the  patients.  It  constitutes  a  ready  index  to  all  cases  currently  on 
the  register.  Cards  will  be  transferred  from  the  current  file  to  the 
permanent  file  immediately  upon  their  completion  and  the  prepara- 
tion of  their  report  cards. 

(&)  The  permanent  file  will  comprise  all  the  register  cards  of  com- 
pleted cases.  The  cards  therein  will  be  filed  in  the  serial  order  of 
their  register  numbers. 

(c)  A  card  index  to  the  register  will  be  kept  on  Form  52a,  one 
index  card  for  each  individual  patient  whose  name  appears  in  the 
register.  When  a  register  card  is  started  and  its  number  determined 
the  index  will  be  searched  for  previous  admissions  of  the  patient. 
If  an  index  card  for  the  patient  is  found,  the  new  number  will  be 
entered  thereon,  and  the  number  of  the  last  previous  admission  will 
be  noted  on  the  new  register  card  (par.  443).  If  no  index  card  for 
the  patient  is  found,  one  will  be  at  once  prepared.  The  index  cards 
will  be  filed  alphabetically  in  dictionary  order  according  to  the  sur- 
names of  the  patients. 

433.  Cases  taken  up  on  register  cards  should  be  borne  thereon 
until  finally  disposed  of.      (See  par.  450.) 

434.  The  cards  will  be  legibly  written  in  indelible  black  ink,  using 
the  typewriter  when  practicable. 

(a)  Entries  must  not  be  crowded.  When  the  space  provided  on 
the  front  of  the  card  under  any  heading  is  not  sufficient  to  complete 
an  entry  thereunder,  the  record  thereof  will  be  continued  on  the 
back  of  the  card,  or,  if  still  more  space  is  required,  upon  an  exten- 
sion slip.     The  extension  slip  must  be  of  the  same  size  as  the  card, 


MEDICAL  DEPARTMENT  447 

and  be  pasted  to  the  lower  margin  o.  the  bacK  of  the  card,  using 
about  one-half  an  inch  for  the  seam ;  this  will  place  the  seam  at  the 
top  of  the  card  when  the  latter  is  filed.  When  an  entry  is  continued 
its  two  parts  should  be  connected  by  cross  references,  using  a  small 
letter  in  parenthesis,  thus,  (a),  so  that  the  record  can  be  readily 
followed. 

435-  The  senior  medical  officer  is  responsible  for  the  correctness 
and  safe-keeping  of  the  register.  He  will  sign  or  initial  all  register 
cards  completed  during  the  period  of  his  responsibility ;  but  at  gen- 
eral hospitals  or  brigade  posts,  or  when  specially  authorized  by  the 
Surgeon  General,  he  may  designate  one  or  more  junior  medical 
officers  to  sign  or  initial  them,  preferably  in  each  case  the  officer  in 
attendance  thereon. 

(a)  When,  in  the  absence  of  a  medical  officer,  the  command  is 
attended  by  a  civilian  physician,  he  will  sign  the  cards  for  the  cases 
completed  under  his  care. 

436.  Alterations  and  additions  wnen  necessary  to  correct  or  com- 
plete the  record  may  be  made  in  the  register  cards  of  uncompleted 
cases  at  the  discretion  of  the  senior  medical  officer  of  the  command 
for  the  time  being.  A  change  of  diagnosis  will  be  indicated  in  the 
space  "  complication,  seq.,  etc.,"  giving  the  date  of  the  change,  and 
the  original  entry  under  "  cause  of  admission  "  will  not  be  disturbed. 
A  change  of  diagnosis  in  such  cases  requires  no  authentication,  as 
its  date  places  the  responsibility  for  it.  Other  changes  should  be 
authenticated  by  the  initials  of  the  officer  who  makes  them.  (Sec 
par.  213.) 

(a)  Alterations  and  additions  to  the  register  cards  of  completed 
cases  may  be  made  in  like  manner  by  the  medical  officer  who  was 
responsible  for  the  card  at  the  time  it  was  completed  if  he  is  still 
the  senior  medical  officer  of  the  command.  If  he  has  been  super- 
seded the  card  will  not  be  changed,  but  a  successor  who  concludes, 
upon  information  received,  that  the  card  is  erroneous  in  any  par- 
ticular may  file  a  supplemental  card  therewith  of  the  same  size  as  the 
register  card,  indicating  thereon  such  conclusion  and  the  information 
or  reasons  upon  which  it  is  based.  The  supplemental  card  should  be 
headed  "  Supplemental  card,  No. ,"  inserting  the  register  num- 
ber of  the  register  card,  and  should  be  dated  and  signed  by  the 
officer  filing  it.  A  cross  reference  to  the  supplemental  card  indenti- 
fying  it  by  its  date  may  appear  upon  the  register  card,  but  it  will  be 


448  GENERAL  MEDICAL  ADMINISTRATION 

a  reference  only,  thus,  "  See  supplemental  card  dated ,"  and 

contain  none  of  the  matter  recorded  on  the  supplement.     (See  pars. 
462,  463,  and  464.) 

REPORT  OF  SICK  AND  WOUNDED 

457.  The  report  of  sick  and  wounded  comprises,  (i)  the  report 
sheet  (Form  51),  which  provides  for  general  information  and 
numerical  tabulations  concerning  the  command  and  the  civilians 
therewith;  (2)  the  nominal  check  list  (Forms  51a  and  51&)  for  a 
chronological  list  of  cases  registered;  (3)  the  report  cards  (Form 
52)  for  details  of  the  several  cases. 

458.  Subject  to  exceptions  similar  to  those  indicated  in  paragraph 
427,  this  report  is  required  monthly  from  every  military  post  and 
separate  command  which  is  attended  by  a  medical  officer  or  civilian 
physician.  It  will  be  rendered  separately  for  regular  and  volunteer 
troops,  that  of  regulars  to  embrace  all  data  pertaining  to  civilians. 
It  will  be  forwarded  before  the  fifth  day  of  the  next  succeeding 
month  as  follows :  From  a^general  hospital  or  other  independent 
post  or  command  direct  to  the  Surgeon  General,  unless  otherwise 
ordered  by  him ;  from  a  transoceanic  Army  transport  to  the  medical 
superintendent  of  the  transport  service  at  the  transport's  home  port, 
for  transmittal  to  the  Surgeon  General ;  and  from  any  other  organ- 
ization or  hospital  to  the  department  surgeon  for  like  transmittal. 

(a)  When  a  hospital  is  closed  or  a  command  is  discontinued  a 
report  covering  the  unreported  period  of  service,  giving  the  begin- 
ning and  the  end  thereof,  will  in  like  manner  be  forwarded  within 
five  days  thereafter. 

(b)  If  there  has  been  no  case  on  sick  report,  either  remaining 
from  last  report  or  admitted  during  the  month,  Form  51  will  never- 
theless be  forwarded.  It  will  give  the  name  and  strength  of  the 
command,  etc.,  with  such  remarks  as  may  be  deemed  of  interest  to 
the  department  surgeon  or  the  Surgeon  General. 

459.  All  births  and  marriages  occcuring  at  the  post  or  with  the 
command  and  all  deaths  among  the  civilians  with  the  command  will 
be  recorded  on  the  report  of  sick  and  wounded  under  the  heading 
"  Births,  marriages,  and  deaths." 

460.  A  report  card  is  required  for  every  case  registered  during  the 
month,  and  if  the  case  is  not  completed  until  a  subsequent  month  a 


MEDICAL  DEPARTMENT  449 

second  report  card  will  be  forwarded  with  the  report  for  the  month 
during  which  it  is  completed.  With  the  report  for  December,  report 
cards  will  be  forwarded  also  for  all  cases  remaining  December  31 
which  were  registered  previous  to  December. 

(a)  A  duplicate  of  the  report  sheet  and  of  the  nominal  list  will  be 
retained  with  the  medical  records  of  the  post  or  command.  At  a 
permanent  post  the  duplicate  report  sheets  will  be  filed  in  and  form 
a  part  of  its  medical  history.     (See  par.  412.) 

(&)  The  senior  medical  officer  will  fill  in  and  sign  the  certificate  at 
the  foot  of  the  first  page  of  the  report  sheet.  (See  par.  400.)  The 
report  cards  will  be  initialed  as  provided  in  paragraph  435  for  reg- 
ister cards.  If  there  is  neither  medical  officer  nor  civilian  physician 
with  the  command  when  the  report  is  to  be  made,  the  officer  in 
charge  of  the  property  of  the  hospital  will  make  the  report  over  his 
own  signature  and  initial  the  cards. 

(c)  Alterations  should  in  every  instance  be  authenticated  by  the 
initials  of  the  officer  or  physician  who  signs  the  report  and  initials 
the  report  cards  respectively. 


ARTICLE    IX  —  SUPPLIES    AND    MATERIALS — GENERAL 

PROVISIONS 

475.  In  preparing  returns,  requisitions,  invoices,  and  receipts  per- 
taining to  medical  and  hospital  supplies,  the  nomenclature,  order 
of  entry,  classification,  and  weights  and  measures  of  the  supply 
table  will  be  followed.  To  facilitate  the  handling  of  these  papers 
one  line  of  writing  only  will  be  placed  in  each  interlinear  space.  No 
letter  of  transmittal  is  required  with  them. 

REQUISITIONS 

Post  Medical  Supplies 

477.  Annual  requisitions  for  post  medical  supplies  will  be  pre- 
pared on  Form  33,  for  the  year  commencing  January  i,  unless  some 
other  date  is  designated  by  the  Surgeon  General. 

(a)  They  will  be  forwarded  not  less  than  20  days  before  the 
beginning  of  the  year,  to  the  department  surgeon,  in  quadruplicate, 
29 


450  GENERAL  MEDICAL  ADMINISTRATION 

or  in  the  case  of  general  hospitals  and  independent  posts  direct  to 
the  Surgeon  General  in  triplicate. 

478.  Articles  of  which  a  definite  allowance  is  given  on  the  supply 
table  will  be  required  for  on  the  annual  requisition  except  as  other- 
wise  provided  in  paragraph  486.  No  remark  will  be  made  opposite 
the  name  of  any  article  that  a  special  kind  or  special  make  or  pattern 
is  wanted,  as  the  annual  requisition  is  intended  to  include  only  such 
articles  as  are  kept  on  hand  in  supply  depots  for  issue,  and  not  such 
as  have  to  be  specially  purchased;  the  latter  when  wanted  must  be 
asked  for  on  special  requisition. 

(a)  Only  such  quantities  will  be  asked  for  as  probably  will  be 
needed  during  the  year,  computed  on  the  basis  of  original  packages. 
Fractional  parts  of  a  bottle  or  package  will  not  be  asked  for.  The 
quantities  asked  for,  plus  the  quantities  on  hand,  must  not  exceed 
those  specified  in  the  table  for  the  official  population  most  nearly 
corresponding  to  that  of  the  post  or  command.  The  quantity  of 
each  article  on  hand,  as  verified  by  a  medical  officer  in  accordance 
with  paragraph  512a,  will  be  stated  and  will  be  deducted  from  the 
quantity  allowed  annually  Ijy  the  supply  table  (ignoring  for  the 
purpose  of  this  deduction  fractional  parts  of  bottles  and  packages 
on  hand)  to  ascertain  the  balance  which  may  be  asked  for,  if  needed. 

(b)  Before  forwarding  an  annual  requisition  it  will  be  carefully 
examined  and  compared  with  the  supply  table  to  see  that  it  has 
been  correctly  made  out  in  strict  accordance  with  these  regulations 
and  to  avoid  the  delay  that  its  return  for  correction  will  occasion 
if  they  are  not  complied  with. 

479.  The  local  prevalence  or  rarity  of  certain  diseases,  as  well  as 
the  quantity  or  number  on  hand  of  each  article,  will  be  considered 
in  the  preparation  and  approval  of  annual  requisitions. 

480.  The  smaller  posts  will  not  need  all  the  articles  included  in 
the  supply  table.  The  surgeon  is  not  expected  to  require  for  an 
article  merely  because  it  is  listed.  He  should  call  only  for  what 
there  is  reason  to  think  he  will  need. 

481.  The  department  surgeon  to  whom  an  annual  requisition  is 
forwarded  will  see  whether  it  is  prepared  in  accordance  with  the 
above  regulations.  If  it  is,  he  will  approve  and  forward  one  copy 
direct  to  the  medical  supply  depot  designated  for  his  territory  by 
the  Surgeon  General ;  if  it  is  not,  he  will  alter  it  to  conform  to  these 


MEDICAL  DEPARTMENT  451 

regulations,  and  then  forward  it  to  the  depot  approved  as  altered. 
In  either  event,  he  will  forward  the  second  copy  of  the  requisition, 
with  the  action  taken  by  him  noted  thereon,  direct  to  the  Surgeon 
General.  He  will  retain  the  third  copy  in  the  files  of  his  office  and 
will  return  the  fourth  copy  to  the  surgeon  with  his  modifications, 
if  any,  noted  thereon. 

482.  Special  requisitions  for  post  medical  supplies  are  annual, 
quarterly,  or  emergency.  They  will  be  made  on  Form  35,  but 
separately  from  those  for  field  medical  supplies  and  those  for  dental 
supplies.  The  same  number  of  copies  will  be  executed,  and  they 
will  be  forwarded  to  the  department  surgeon  or  to  the  Surgeon 
General  direct,  as  in  the  case  of  annual  requisitions  from  the  same 
posts  or  hospitals.     (See  par.  477a.) 

483.  Except  as  otherwise  provided  in  paragraph  486,  articles  not 
on  the  supply  table  which  will  be  needed  during  the  year  will  be 
called  for  on  the  annual  special  requisition.  It  will  be  forwarded 
with  the  regular  annual  requisition.  The  articles  will  be  listed  in 
alphabetical  order,  and  the  necessity  for  them  will  be  fully  explained 
in  the  column  of  "  Remarks."  To  avoid  delay  in  filling  these  requisi- 
tions a  full  description  of  special  articles,  instruments,  and  appli- 
ances required  for  will  be  given  in  "  Remarks,"  together  with  a  state- 
ment of  their  cost  or  approximate  cost,  as  ascertained  from  dealers* 
catalogues  or  other  reliable  sources  of  information.  When  unsual 
drugs  or  chemical  reagents  are  called  for  similar  information  as  to 
their  cost  will  be  furnished. 

484.  Except  as  otherwise  provided  in  paragraph  486  and  in  the 
footnotes  to  the  supply  tables,  articles  on  the  supply  table  of  which 
no  allowance  is  stated,  or  which  are  issued  "  as  required,"  will  be 
called  for  on  the  quarterly  special  requisition. 

FIELD    MEDICAL   SUPPLIES 

489.  Requisitions  to  replenish  field  medical  supplies  or  to  replace 
unserviceable  field  equipment  at  permanent  posts  will  be  executed 
in  triplicate,  on  Form  35,  and  will  be  forwarded  to  the  department 
surgeon,  or,  in  the  case  of  an  independent  post  or  station,  direct  to 
the  Surgeon  General. 

(a)  The  department  surgeon  who  receives  a  requisition  in  tripli- 
cate for  field  medical  supplies  in  conformity  with  this  regulation  will 


452  GENERAL  MEDICAL  ADMINISTRATION 

promptly  forward  the  same,  with  his  recommendations  indorsed 
on  each  copy,  to  the  Surgeon  General.  In  the  Phihppine  and 
Hawaiian  Departments  the  department  surgeons  are  authorized  to 
act  upon  them  as  upon  requisitions  for  post  suppHes.  One  copy  of 
the  requisition  wall  be  returned  to  the  surgeon  with  modifications, 
if  any,  noted  thereon. 

490.  Requisitions  from  permanent  posts  for  field  medical  supplies 
should  be  unnecessary  except  immediately  following  active  military 
operations  or  as  the  result  of  changes  in  the  supply  tables. 

USE   AND   CARE   OF   MEDICAL  PROPERTY 

514.  The  stock  of  alcohol,  alcoholic  liquors,  opium,  and  the  salts, 
derivatives,  and  preparations  of  opium  or  coca  leaves  will  be  kept 
in  a  locked  closet  in  the  storeroom  and  only  issued  to  the  dispensary 
in  unit  containers  from  time  to  time  as  may  be  necessary,  upon  the 
written  order  of  a  medical  officer. 

(o)  In  the  storeroom,  receipts  and  expenditures  of  these  articles 
will  be  accounted  for  in  the  manner  prescribed  for  the  dispensary 
(par.  240). 

515.  Field  supplies  and  equipment  will  not  be  used  as  posts,  except 
when  required  for  purposes  of  instruction. 

516.  Field  chests  and  appliances  will  be  frequently  inspected  and 
kept  in  perfect  order  for  immediate  field  use. 

517.  The  exchange  of  medicines  with  druggists  is  prohibited. 

518.  The  issue  of  articles  for  use  in  the  preparation  of  cleaning 
mixtures,  cosmetics,  or  perfumery,  or  for  use  with  spirit  lamps,  etc., 
is  prohibited. 

519.  The  responsible  officer  will  cause  all  instruments  in  his  charge 
to  be  examined  by  a  commissioned  medical  officer  at  least  once  each 
month. 

520.  Steel  and  plated  instruments  may  be  prevented  from  rusting 
by  keeping  them  in  a  20  per  cent  formalin  solution  saturated  with 
borax. 

523.  Blankets  not  in  use  should  be  frequently  examined  and  prop- 
erly protected.  When  stained  but  otherwise  in  good  condition  they 
should  be  continued  in  service.  Hospital  bedding  will  not  be  used  by 
members  of  the  Hospital  Corps,  except  when  on  duty  in  the  wards. 

524.  When  a  typewriter  is  to  be  transported  the  ribbon  spools 


MEDICAL  DEPARTMENT  453 

should  be  removed  and  packed  separately,  the  carriage  of  the  machine 
securely  tied  to  the  base  in  such  a  manner  that  it  can  not  move  in 
any  direction,  and  the  steel  rods  or  blocks  for  locking  the  carriage 
placed  in  position.  Medical  officers  will  be  held  responsible  for 
damages  to  typewriters  which  result  from  careless  packing. 

525.  Rubber  and  flexible  catheters  and  bougies  will  be  kept  in  talc 
or  glycerin  to  preserve  them. 

526.  When  the  canvas  in  litters  becomes  soiled  it  will  be  removed 
from  the  litters,  washed,  and  replaced.  When  it  becomes  torn  or 
unserviceable  new  canvas  of  the  proper  size  should  be  applied  for  to 
replace  it. 


Part  II  —  The  Sanitary  Service  in  War. 

ARTICLE  VIII— THE  SANITARY  SERVICE  IN  WAR — GENERAL 
CORRESPONDENCE,  REPORTS,  RETURNS  AND  RECORDS 

Records  of  Sick  and  Wounded 

$6y.  During  and  after  an  engagement  diagnosis  tags  will  be 
attached  to  all  wounded  and  dead  as  soon  as  practicable.  They  will 
be  made  out  in  duplicate. 

568.  In  the  case  of  wounded  the  primary  purpose  of  the  tag  is  to 
advise  the  medical  officers  under  whose  observation  the  wounded 
successively  come  of  the  treatment  previously  given  at  the  several 
points  of  relief  on  the  field  or  on  the  way  to  the  rear. 

569.  The  tag  will  be  made  out  by  the  first  medical  officer  or 
member  of  the  Hospital  Corps  who  treats  the  man  previous  to  ad- 
mission to  a  hospital  on  the  line  of  communications.  (It  is  unneces- 
sary to  tag  a  patient  who  is  admitted  to  a  hospital  on  the  line  of 
communications  without  having  been  previously  tagged.)  If  the 
patient  is  badly  hurt,  the  identification  tag  may  be  utilized  to  obtain 
the  necessary  information  concerning  his  name,  rank,  etc.  The 
original  diagnosis  tag  will  be  attached  to  the  patient's  clothing. 

570.  The  dead  found  on  the  field  will  be  tagged  in  each  case  by 
the  Medical  Department  troops  who  first  reach  the  body,  in  order 


454  THE  SANITARY  SERVICE  IN  WAR 

that  other  medical  personnel  may  not  lose  time  examining  it.     The 
tag  will  be  attached  to  the  clothing  of  the  deceased. 

5/1.  The  duplicates  of  the  diagnosis  tags  will  be  disposed  of  as 
follows : 

(a)  Those  made  out  by  the  sanitary  personnel  of  an  organization 
for  the  officers  and  soldiers  of  their  own  command  will  be  retained 
by  the  surgeon  until  disposed  of  as  provided  in  paragraph  574. 

(b)  Those  made  out  for  officers  and  soldiers  of  other  commands 
will  be  transmitted  as  soon  as  possible  after  the  close  of  each  day  of 
an  engagement  to  the  division  surgeon  accompanied  by  the  check 
list  directed  to  be  sent  to  that  officer  by  paragraph  579. 

572.  The  original  tags  will  be  disposed  of  as  follows : 

(c)  Those  of  wounded  who  are  returned  from  aid  stations  to  the 
firing  line  without  going  farther  to  the  rear  will  be  removed  and 
retained  by  the  regimental  surgeon. 

(b)  Those  of  wounded  who  are  returned  to  their  organizations 
direct  from  dressing  stations  (par.  682)  or  from  the  station  for 
slightly  wounded  (par,  714a)  will  be  removed  upon  their  reporting 
for  duty  and  be  turned  over  to  the  surgeons  of  their  several  organiza- 
tions, respectively. 

(c)  Those  of  wounded  who  are  admitted  to  a  field  hospital  and 
retained  there  for  definitive  treatment  will  be  removed  and  for- 
warded to  the  division  surgeon.  If  the  patients  are  subsequently 
transferred  to  the  line  of  communications,  they  will  not  be  retagged, 
but  will  be  accompanied  by  transfer  lists  in  regular  form  (par.  583). 

(d)  Those  of  wounded  who  are  being  evacuated  from  the  zone  of 
the  advance  will  not  be  disturbed  until  the  patients  are  admitted  to 
hospital  on  the  line  of  communications,  when  the  tags  will  be  re- 
moved, stamped  with  the  name  of  the  admitting  hospital,  and  the 
date  of  receipt  of  the  patient,  and  forwarded  immediatel}'  to  the 
division  surgeon  of  the  division  to  which  the  wounded  belong. 

(c)  Those  of  wounded  who  die  while  in  transit  from  the  field  to 
hospital  (the  death  in  each  case  being  noted  on  the  tag  as  required 
by  the  printed  instructions  in  the  tag  book),  and  the  tags  attached  to 
the  dead  found  on  the  field,  will  be  removed  when  the  bodies  are 
prepared  for  interment  or  equivalent  disposal,  and  will  be  sent  like- 
wise to  the  division  surgeon. 

573.  The  division  surgeon  will  cause  the  tags  received  by  him  in 


MEDICAL  DEPARTMENT  455 

compliance  with  paragraphs  571  and  572  to  be  distributed  without 
delay  to  the  senior  medical  officers  of  the  commands  to  which  the 
men  tagged  belong,  so  that  they  may  be  available  in  accounting  for 
officers  or  soldiers  who  would  otherwise  be  carried  as  missing  on  the 
returns  of  their  organizations. 

574.  Having  served  their  purpose  in  completing  the  records  of  the 
organizations,  all  the  tags,  both  originals  and  duplicates,  will  be  for- 
warded with  the  next  periodical  lists  of  sick  and  wounded  therefrom. 

575.  The  register  of  patients  prescribed  by  paragraph  427  and 
the  monthly  report  of  sick  and  wounded  by  paragraph  458  are  not 
required  from  mobile  troops  or  commands  in  the  theater  of  opera- 
tions. In  lieu  thereof  a  record  or  list  of  the  sick  and  wounded  with 
every  mobile  command  in  the  theater  of  operations  which  is  accom- 
panied by  a  medical  officer  will  be  kept  day  by  day  by  such  officer  on 
Form  53,  as  directed  in  the  following  paragraphs  and  in  the  in- 
structions printed  on  the  form.  Field  hospitals  immobilized  and 
acting  as  camp  hospitals,  evacuation  hospitals,  base  hospitals,  supply 
depots,  contagious  disease  hospitals,  field  laboratories,  and  other 
similar  sanitary  formations  will  not  be  regarded  as  mobile  units 
within  the  meaning  of  this  paragraph,  but  will  keep  the  register  of 
patients  and  render  monthly  reports  of  sick  and  wounded  in  accord- 
ance with  the  regular  rule. 

576.  The  list  of  sick  and  wounded  will  contain  a  record  of  the 
following  cases: 

(a)  Every  officer  or  soldier  with  the  command  who  is  excused 
from  duty  on  account  of  sickness  or  injury,  or  who  receives  a  wound 
of  any  character  in  action  whether  it  involves  excuse  from  duty  or 

not. 

(b)  Every  officer  or  soldier  with  the  command,  not  currently  on 
the  list,  who  is  sent  to  another  command  or  place  for  observation  or 
treatment. 

(c)  Every  officer,  not  currently  on  the  list,  who  departs  from  the 
command  on  sick  leave. 

(d)  Every  officer  or  soldier  with  the  command,  not  currently  on 
the  Hst,  who  is  retired,  or  discharged  for  disability,  or  dies;  and 
every  civilian  with  the  command  who  dies. 

577.  In  determining  the  cases  to  be  entered  on  the  list  of  sick  and 
wounded  under  the  provisions  of  paragraph  576,  officers  and  soldiers 


456  THE  SANITARY  SERVICE  IN  WAR 

who  are  killed  or  wounded  in  action  will  be  considered  as  with  the 
command  by  whose  .sanitary  personnel  they  are  tagged.  The  names 
of  such  officers  and  soldiers  will  therefore  not  necessarily  appear  on 
the  list  of  sick  and  wounded  of  their  own  organization.  (See 
par.  579a.) 

578.  Except  as  provided  in  paragraph  580,  the  list  of  sick  and 
wounded  will  be  made  in  duplicate,  and  at  the  end  of  the  motnh 
covered  by  it  the  original  thereof  will  be  forwarded  through  medical 
channels  to  the  Surgeon  General.     The  duplicate  will  be  retained. 

580.  Stations  for  slightly  wounded  will  make  a  single  copy  of  the 
list  of  sick  and  wounded.  At  the  end  of  each  day  and  when  the 
station  is  closed  the  list  will  be  sent  at  once  to  the  division  surgeon. 

581.  Evacuation  ambulance  companies  should  include  in  their  list 
of  sick  and  wounded  only  such  cases  as  pertain  to  their  own  personnel 
and  such  cases  as  may,  under  exceptional  circumstances,  fall  mto 
their  hands  without  having  been  previously  tagged  by  other  sanitary 
formations. 

582.  Hospital  trains  and  hospital  ships  make  complete  lists  in 
regular  monthly  form  only  of  cases  occurring  among  their  own  per- 
sonnel and,  in  the  case  of  a  hospital  ship,  of  cases  admitted  thereto 
for  definitive  treatment. 

583.  Where  patients  are  transferred  from  mobile  organizations  at 
the  front  to  the  line  of  communications  a  nominal  list  of  them  should 
if  practicable  be  prepared  in  duplicate  by  the  transferring  officer, 
the  original  of  which  should  be  receipted  and  returned  to  him  by  the 
receiving  officer.  Extra  carbon  copies  of  so  much  as  may  be  per- 
tinent of  the  transferring  officer's  regular  list  on  Form  53  may  be 
made  for  this  purpose.  Transfers  from  camp  hospitals  in  the  zone 
of  the  advance,  should  there  be  any  such,  will  be  accomplished  by 
regular  transfer  cards  (par.  575). 

(a)  The  duplicates  of  the  nominal  lists  mentioned,  or  the  transfer 
cards,  as  the  case  may  be,  furnished  as  above  to  an  evacuation  ambu- 
lance company,  will  be  turned  over  to  the  evacuation  hospital  or 
other  sanitary  formation  to  which  it  delivers  the  patients.  Similar 
disposition  will  be  made  by  a  hospital  train  or  hospital  ship  of  the 
nominal  lists  or  transfer  cards  received  by  it. 

584.  Should  a  hospital  train  or  hospital  ship  receive  patients  unac- 
companied by  nominal  lists  or  transfer  cards,  the  commanding  officer 


MEDICAL  DEPARTMENT  457 

of  the  train  or  ship  will  as  soon  as  practicable  prepare  a  nominal  list 
of  such  patients  on  Form  53  (separate  and  apart  from  his  regular 
monthly  list  of  sick  and  wounded)  for  disposition  as  above  provided. 
Should  the  preparation  of  such  a  list  be  impracticable  he  will  list  the 
patients  who  seem  to  be  in  danger  of  death  so  as  to  be  able  if  death 
occurs  to  report  the  necessary  details. 


PART  X 

CLERICAL  WORK 

Not  all  sanitay  soldiers  will  make  good  clerks,  but  selected  pri- 
vates first  class  and  privates  who  show  special  aptitude  are  required 
to  take  the  course. 

The  nature,  objects,  and  methods  of  preparation  of  the  follow- 
ing reports  and  records  are  to  be  explained  to  the  class  and  copies 
prepared  and  criticized.  Each  member  of  the  class  should  be  re- 
quired  to  prepare  various  reports.  The  list  includes  the  usual  reports 
and  returns  required  of  officers  of  the  Medical  Department  in  time 
of  peace  (for  reports  made  under  field-service  conditions  only,  see 
par.  558,  M.  M.  D.)  : 


Name    of   report,    etc. 


(o)  Daily. 

(i)    Surgeon's  morning  re- 
port of   sick. 


(2)  Morning    report,     de- 

tachment   of    Hospi- 
tal Corps. 

(3)  Daily  sick  report,  de- 

tachment   of    Hospi- 
tal  Corps. 

(b)  Trimonthly. 

(i)   Trimonthly   report   of 
enlistments. 


(<r)   Monthly. 

(i)  Personal  report  of 
medical  officer,  den- 
tal surgeon,  acting 
dental  surgeon,  or 
contract  surgeon. 

(2)  Return  of  the  Hos- 
pital Corps. 


Form  No. 


71,  M.  D. 


332,  A.   G.  O. 
339,  A.  G.  O. 

18,  A.  G.  O.. 


Letter 


47a,  M.  D. 


e8 

To    whom   sent. 

Remarks. 

^  ° 

I 
I 

c    0     

c.  0 

call.      Returned 
by  the  adjutant 
to   the   hospital. 
Do. 

I 

Kept    at    hospital . . 

2 

I  to  The  A.  G.;   i 
retained. 

At  recruit  depots 
and  depot  posts 
made  by  com- 
manding officer. 
At  other  garri- 
soned posts  and 
stations  made 
by  recruiting 
officer. 

2  or  I 

2  to  S.  G.  through 
D.     S.    or     I     di- 
rect. 

See  pars.  la,  13, 
18,  19,  32,  and 
SS- 

2 

I   to  S.  G.   through 
D.    .S.    or    direct; 
:   retained. 

Nfonthly  return 
for  field  use 
only.  See  par. 
SO. 

(459) 


460 


CLERICAL  WORK 


i-.a 

Nan-.e   of  report,   etc. 

Form  No. 

II 

To   whom  sent. 

Remarks. 

(c)  Monthly — Con. 

(3)   Efficiency     report    of 

62,  M.  D 

2 

I    to    D.    S.    or    to 

See   par.    99. 

nurses. 

S.      G.;      I      re- 
tained. 

(4)   Return  of  the  Nurse 
Corps. 

63,  M.  D 

2 

do    

See    par.    98. 

(s)  Pay      rolls,      enlisted 

366,  W.  D.;  366a, 

3 

3  to  C.  0 

I  returned  to  sur- 

men. 

W.   D. 

geon  to  be  re- 
tained. 

(f)   Pay  roll,  Army  Nurse 

334,  W.  D.;  3340, 

3 

2     to     paying     Q. 
M. ;    I    rentained. 

Corps. 

W.   D. 

(7)   Ration  return  of  ma- 

223, Q.  M.  C 

2 

I   to  C.   0.;  memo. 

tron    and    others    ra- 

kept   at   hospital. 

tioned  separately. 
(8)   Voucher    for    commu- 

3SI, W.  D 

2 

2  to  C.  0 

I    original    and    1 

tation   of    rations   of 

memorandum. 

enlisted   men.    Army 

Nurse     Corps,     etc., 

in   hospital. 

(9)    Statement  of  hospital 

49,  M.  D 

2 

I    to    D.    S.    or    to 

See      pars.      260, 

fund. 

S.      G.;      I      re- 
tained. 

261,  and  262. 

(10)   Report    of   sick   and 

51,  M.  D.;  510,  M. 
D.;  sib,  M.  D.; 

2 

I   to   S.   G.  through 

See    pars.    457    to 

wounded. 

D.   S.,  or  direct; 

464. 

52,  M.   D. 

I   retained. 

(11)  Report      of      dental 

57,  M.  D 

2 

I  to   S.   G.  through 

See  par.  473. 

work. 

- 

medical          chan- 
nels;   I    retained. 

(12)   Sanitary  report 

so,  M.  D 

2 

I     to    The     A.     G. 
throurh    military 
channels;     i     re- 
tamed. 

See  pars.  414  to 
417. 

(13)  Report     of     medical 

26s,  A.  G.  0 

2 

I   to  The  A.  G.;    i 

examinations    of    ap- 

retained. 

plicants     for     enlist- 

ment. 

(14)   Report    of    progress 
of     repairs     to     hos- 

Letter     

I 

S.   G 

See  par.   24s. 

pital. 
(is)   Report    of    progress 
of    repairs    to    quar- 

    do   

I 

S.    G 

Do. 

ters      of      sergeants 

first    class,    Hospital 

Corps. 

(16)   Voucher  for  hospital 

330  or  330a,  W.  D. 

2 

2    to    D.    S.    or    to 

I    original    and    i 

laundry  not  done  by 

the  S.  G. 

mem  orandum. 

hospital   matron. 

See    par.    277. 

(17)   Account  current   ... 

320b  or  320,  W.  D. 

2 

I    to    S.    G. ;    I    re- 
tained. 

Accompanied  by 
the  appropriate 
vouchers. 

(18)  Report   of  issues   of 
medicine      to      civil- 

Letter     

I 

I     to     S.     G.;     in 

See  par.  244. 

Philippine        De- 

ians. 

partment             to 
D.   S. 

(19)  Requisition    for    for- 
age. 

(20)  Report    of    ordnance 

218,  0.  M.  C 

94,  0.  D 

2 

2  to  C.  0 

2 

I    to    Q.    M.,    who 

charges     on     muster 

pays    the   detach- 

and pay   rolls. 

ment;        I        re- 
tained. 

(21)   Statement  of  charges 

208,  Q.  M.  C 

3 

2   to   0.   M.;    I    re- 

- 

quartermaster     prop- 

tained. 

erty. 

(22)   Report     of     meteor- 

Weather  Bureau. 

1 

Throurh       director 

From     designated 

ological  observations. 

State      section 
Weather    Bureau 
to  S.  G. 

posts.  See  par. 
527. 

CLERICAL  WORK 


461 


Name   of  report,   etc. 


Form  No. 


es 


(cf)   Bimonthly. 

(i)  Muster  roll,  detach- 
ment of  Hospital 
Corps. 

(2)  Muster  roll,    soldiers 

in  hospital. 

(3)  Return    of    the    Hos- 

pital  Corps. 

(e)   Quarterly. 

(i)  Special  requisition 
for  medical  supplies 


(2)  Requisition   for  table- 

ware     and      kitchen 
utensils. 

(3)  Certificate    of    break- 

age,       china        and 
glassware. 

(/)   Semiannually. 

(i)   Return     of    ordnance 
and  ordnance  stores 


21,  A.  G.  O 

....    do    

4r,  M.  D 

35.  M.  D 

166,  Q.  M.  C... 
207,  Q.  M.  C... 


iS,      O.      D.;      1: 
cover. 


(2)  Statement  of  charges  86,  O.  D 

for  ordnance  prop- 
erty on  muster  and 
pay  rolls. 

(3)  Return        of        horse    180,   O.   D. 

equipments. 

(4)  Requisition  for  blanks  37,    M.    D. 


(g)  Annually. 

(i)   Statement    of   prefer 
cnces. 

(2)  Efficiency     report     of 

officers. 

(3)  Requisitions  for  med- 

ical  supplies. 


(4)  Report      of      surgica 

operations. 

(5)  Statement   of  repairs, 

etc.,  to  hospital. 

(6)  Statement   of   repairs 

etc.,  to  qi'arters  of 
sergeants  first  class 
Hospital  Corps. 

(A)  Occasionally. 

(i)  Ration  return,  dc 
achment  of  Hos- 
pital Corps. 


423,  A.  G.  O.. 
429,  A.   G.  O.. 


33,  M.  D.;  35.  M-  4  or  3 
D. 


58,  M.  D 
Letter  ... 
....    do    . 


223,  Q.  M.  C. 


To   whom   sent. 


Remarks. 


to       mustenn; 
officer. 


do 


to  S.  G.  through 
U.  S.  or  direct; 
I   retained. 


4     to     D.     S. 
from       independ- 
ent    posts,     3     to 
S.    G. 

2    to   C.   O.;    I 
tained. 


Q.  M. 


I  returned  to  hos- 
pital   to    be  •  re- 
tained. 
Do. 

Din'.onthly  return 
in  carrison.  See 
par.    so. 


I  returned  to  sur- 
geon to  be  re- 
tained. See  par. 
482  et  scq. 

When  IIo<-pital 
Corps  detach- 
ment is  messed 
separately. 

When  Quarter- 
master Corps 
china  and  rla-^s- 
ware  are  used. 


I  to  C.  of  O.  (ex 
cept  in  Philip 
pine  Depart- 

ment, where  to 
D.  O.  O.);  I 
retained. 

....    do    


do 


to  S.  G.  (except 
in  Philippine 

I)  e  p  a  r  tment 
where  to  D. 
S.);    I    retained. 


To   The   A.    G.    di 

rect. 
To      The      A.      G 

through  mili 

tary    channels. 
4     to     D.      S.      01 

from      independ 

ent    posts,     3     to 

S.  G. 
I    to    D.    S.    or    to 

S.   G. 
Q.    M 


do 


Vouchers    to 
company. 


To  accompany  re- 
turn. 


Vouchers    to     ac- 
company. 


See  instructions 
on  the   form. 

See  Army  Regu- 
lations. 

I  returned  to  sur- 
geon to  be  re- 
tained. See  par. 
477   ct  scq. 

See  pars.  418, 
419,  and  420. 

See    Army    Regu- 
la'ions. 
Do. 


to  C.  O.;  memo 
copy_  kept  at 
hospital. 


Made  at  such  in- 
tervals as  the 
('.  O.  may 
direct. 


462 


CLERICAL  WORK 


Name   of  report,   etc. 


Form  No. 


(/i)   Occasionally — Con. 

(2)  Report   of   change   of 

station  or  status,  M. 
O.,  D.  S.,  A.  D.  S., 
C.  S.,  H.  C,  or  A. 
N.  C. 

(3)  Change  of  station,  M. 

O.,   D.   S.,   or  C.   S. 

(4)  Report    of    death    of 

officer. 


(S  )  Report  of  death  of 
officer,  enlisted  man, 
or  civilian. 

(6)  Report    of     death     of 

M.  O.,  D.  S.,  A.  D. 
S.,  C.  S.,  or  Sergt. 
f.  c,  H.  C. 

(7)  Certificate  of  death.. 

(8)  Inventory    of    effects, 

deceased  officer,  en- 
listed man,  or  civil- 
ian. 

(9)  Efficiency    report    on 

officers. 


(10)   Efficiency         report, 
Army    Nurse   Corps. 


(11)  Efficiency  report, 
Hospital  Corps. 

(12)  Record  of  assign 
ment  and  pay,  Army 
Nurse  Corps. 

(13)  Enlistment  paper  of 
soldier  enlisting  or 
reenlisting. 

(14)  Report  of  physica 
examination  of  re 
cruit. 

(15)  Identification  record 
recruit. 


(16)  Designation  of  bene 
ficiary. 

(17)  Descriptive  and  as 
signment  card,  re- 
cruit. 

(18)  Account  of  clothing 
issued  to  recruit. 

(19)  Descriptive  list   . 


Letter 


....    do 


Telegram 


Letter    .. 
....    do 


Local   form    . 
34.  A.  G.   O. 


429,  A.  G.  O 


62,    M.    D. 


80,    M.    D... 

66,    I.I.    D... 

22,  A.  G.  O. 

I3S.  A.  G.   O 

260,    A.     G.     O 
261,  A.  G.   O 

3 So,  A.  G.  O.. 

25,  A.  G.  O... 

140,  A.   G.   O.. 

29,  A.  G.  O... 


Usual- 
ly 2 
3 


To   whom  sent. 


2  to  S.  G.  through 
D.  S.  or  I  di- 
rect. 


To   The   A,    G,    di- 
rect. 


To  The  A.  G. 


C.   O. 


to    D.    S.,    I    to 
S.   G. 


To       local       health 

officer. 
2  to  The  A.   G.;    i 

retained. 


To  officer's  new 
C.  O.  or  to  sur- 
geon of  his  new 
station. 

I   to  C.    O.   of  hos 
pital      to      which 
transferred; 
retained. 

1  forwarded 
D/L.;  I 
tamed. 

I  to  nurse's 
C.  O.;  1 
tained. 

As  prescribed  on 
the  form. 


with 


The    A.    G.    direct. 


The  A.  G.;  in  the 
Philippine  De- 
partment to  the 
C.    G.   thereof. 

The    A.    G.    direct. 


C.  o. 


To  accompany  de- 
scriptive and  as- 
signment card. 

Number  and  dis- 
position accord- 
ing to  circum 
stances  as  pre- 
scribed in  regu 
lations. 


Remarks. 


See  pars.  12,  13, 
18,  19,  32,  45, 
5S,  and  100. 


See    Army    Regu- 
lations. 

Of  officers  on  ac- 
tive list  who 
have  no  imme- 
diate command- 
ers, and  of 
officers  on  the 
retired  list. 

See  par.   218. 


See  par.  219. 


See  Army  Regu- 
lations.: De- 
ceased Soldiers. 

.See  Army  Regu- 
lations. 


See  par.  99. 

See  par.  46. 
See  par.  76b. 


Notation         made 
on  soldier's 

D/L. 


CLERICAL  WORK 


463 


Name   of  report,   etc. 


Form  No. 


(A)    Occasionally — Con. 

(20)  Reservist's      descrip- 
tive card. 

(21)  Notification  of  trans- 
fer to  Army  reserve. 

(22)  Allotment  of  pay... 

(23)  Discontinuance        of 
allotment  of  pay. 


(24)  Report  of  soldier's 
deposit. 

(25)  Advice  of  soldier's 
deposits. 

(26)  Report  of  transfer, 
desertion,  or  death 
of  soldier  having 
deposits. 

(27)  Finl  statement,  en 
listed  man. 

(28)  Notification  of  dis 
charge,  enlisted 
man. 

(29)  Discharge  certificate, 
enlisted  man. 


(30)  Certificate      of      dis- 
ability. 

(31)  Furlough     

(32)  Statement  of  service. 


443,  A.   G.  O. 

559,  A.  G.   O. 

38,  Q.  M.  C. 

39,  Q.  M.  C. 


Letter    

8a,    Q.    M.    C. 

No       form 
scribed. 


370,    W.    D. 
3,  A.   G.  O. 


525,     A.     G.     O.; 

526,  A.   G.    O.; 

527,  A.  G.  O. 


17,  A.  G.  O. 

66,  A.  G.  O. 
,5,  A.  G.  O. 


(33)  Certificate  of  in 
debtedness  of  em 
ployee  for  hospital 
service. 

(34)  Special  requisition 
for  medical  sup 
plies. 


(35)  Requisition  for  cloth- 
ing   (in   bulk). 

(36)  Requisition  for  cloth- 
ing  (individual). 


(,37)   Statement    of    cloth- 
ing. 

(38)  Requisition    for   ord- 
nance. 

(39)  Return     of     medical 
property. 


490,  M.  D. 


3S.    M.    D., 

2,3,  Q.  M.  C... 
i6s,  Q.  M.  C.... 

1656,  Q.  M.  C... 

386,  O.  D 

17.  M.  D.;  17" 
M.  D.;  17b-  M 
D.;   17c,  M.  D.I 


To   whom   sent. 


Remarks. 


:  to  reservist;  i  to 
office  where  rec- 
ords  are   kept. 

I  to  The  A.  G.  di- 
lect;    I    retained. 

I  to  Q.  G. ;  I  re- 
tained. 

Q.  G 


C.     O. 

roll. 

Q.   G. 

Q.  G. 


with     pay 


A3     prescribed     on 

the  form. 
Paying   Q.    M. 


Soldier 


c.  o 

....    do   

To  accompany 

charges  against 
enlisted  man 

for  trial  by 
court-martial. 

As  required  by 
Army  Regula- 
tions. 

4  to  D.  S.  or  3  to 
the   S.   G. 


3   to    Q.   M.    direct. 
2  to   Q.   M.   direct 


ee        Appendix: 
Army     —     Re- 
serve. 
Do. 


Notation  of  dis- 
c  o  n  t  i  n  - 
uance  made 

on  retained 

copy     of     allot- 
men   of  pay. 


In  urgent  ca?es 
report  by  tele- 
graph. 


See  Army  Regu- 
lations: Final 
payment,  en- 
istcd  men. 

To  be  piven  by 
field  officer  of 
soldier's  regi- 
ment or  corps, 
or  by  the 
command- 
ing  officer 

when  no  field 
officer  is  pres- 
ent. 


Retained 


2    to    C.    O.; 

tained. 
I    to    S.   G.; 

tained. 


1       returned 
sur^'eon     to 
retained, 
par.   485. 

to 

be 
See 

Separate  slips  for 
each              man 
drawing      cloth- 

Filed    _  with 
uisition 
which     it 
tains. 

req- 

to 

per- 

See  par.  507. 

464 


CLERICAL  WORK 


Name  of  report,  etc. 


(/i)  Occasionally — Con. 

(40)  Report  of  survey... 

(41)  Inventory  and  in- 
spection   report. 

(42)  Special  sanitary  re- 
port. 

(43)  Rejiort  on  officer  or 
enlisted  man  who 
has  been  in  general 
hospital  three 
months. 

(44)  Report  of  appear- 
ance of  epidemic  dis- 
ease at  or  near  a 
military  post  or  sta- 
tion. 

(45)  Report  of  appear- 
ance of  epidemic 
disease  in  a  military 
command  en  route 
to  new  station. 

(46)  Notification  to  local 
board  of  health  pi 
appearance  of  in- 
fectious disease  at  a 
military   post. 

(47)  Reports  of  births... 

(48)  Reports   of   deaths. . 

(49)  Special  reports  of  in- 
teresting  cases. 


(50)  Report  of  change  of 
combination  of  lock 
of  hospital  safe. 

(0  On  Breaking  up  of 
Hospital 

(i)  Current  periodical  re- 
ports and  returns  to 
be  completed. 


(2)  Retained  records 


Form  No. 


196,  A.  G.   O... 

I,    I.    G.   D 

Letter    


Manuscript 


Letter 


....   do 


Letter      or      local 
form. 


V.    S.    109. 

V.   S.   98.. 
Letter    


3mi 


To   whom  Bent. 

Remarks. 

3  to  C.  0 

2       to       inspecting 
officer. 

To      The      A.      G. 
through           mili- 
tary  channels. 

2  to  S.   G 

See    Army    Regu- 
lations. 

See   par.   416. 

See  par.  287. 

I    to    C.    0.;     I    to 
D.  S.;  I  to  S.  G. 

See  par.  201. 

3   copies  as  in  pre- 
ceding   case;    ad- 
ditional   copy    to 
surgeon    of    new 
station. 

B6ard     of    health.. 

Do. 
See  par.   203. 

To       Director       of 

Census. 
do    

See  par.  401. 
Do 

S.        G.        through 
medical          chan- 
nels. 

S.   G 

By  the  attending 
physician.  See 
pars.  421  and 
422. 

See  par.  247. 

Number    of    copies 
and       disposition 
as  at  the  end  of 
full    stated    peri- 
ods in  each  case. 

The     A.     G.     with 
schedule. 

LIST   OF   RECORDS 

The  following  list  includes  all  the  principal  records  required  to  be 
kept  in  military  hospitals  in  addition  to  retained  copies  of  reports, 
returns,  etc. : 

(i)  Register  of  sick  and  wounded  (Form  52). 

(2)  Clinical  records  (Forms  55,  a  to  «). 

(3)  Prescription  files  (par.  240). 

(4)  Register  of  dental  patients  (Form  79). 


CLERICAL  WORK  465 

(5)  Correspondence  records  (pars.  402  to  406). 

(6)  Record  of  instruction  of  the  Hospital  Corps  (pars.  163  and 
178). 

CORRESPONDENCE  RECORDS 

The  record  card  system,  as  prescribed  in  War  Department  orders, 
will  be  used  for  recording  and  filing  the  correspondence  at  the  offices 
of  department  surgeons,  unless  otherwise  directed  by  higher 
authority,  and  at  general  hospitals,  medical  supply  depots,  and  such 
other  offices  as  may  be  specially  authorized  to  employ  it. 

The  correspondence  book  system,  as  prescribed  in  War  Depart- 
ment orders,  will  be  used  for  recording  and  filing  the  correspondence 
of  all  post  hospitals  and  other  sanitary  formations  not  mentioned 
in  the  preceding  paragraph,  except  those  for  which  some  other 
system  is  specially  prescribed. 

All  the  usual  reports  and.  returns  required  of  medical  officers  in 
time  of  peace  are  given  in  paragraph  398,  M.  M.  D.  Such  of  these 
as  are  applicable  to  the  changed  conditions  will  be  made  in  time  of 
war.  The  following  special  reports  and  forms  are  required  only 
during  campaign : 

(a)  Daily  field  report  of  sanitary  personnel  and  transportation 
(Form  82). —  This  report  will  be  made  daily  to  the  proper  medical 
superior  by  the  senior  medical  officer  of  every  organization  in  the 
field,  a  copy  being  retained.  Telegraphic  report  of  the  data  called 
for  thereon  may  be  required  if  necessary. 

(b)  Daily  field  report  of  patients  (Form  83).— This  report  will 
likewise  be  rendered  daily,  as  in  the  preceding  case. 

(c)  Monthly  reports  from  divisional  sanitary  inspectors  required 
by  paragraph  7470,  M.  M.  D.,  Form  50. 

(d)  Reports  of  the  sanitary  inspections  of  Medical  Department 
organizations  required  by  paragraph  748a,  M.  M.  D.,  Form  50&. 

(e)  Certificate  of  identity  (Form  61).— This  certificate  is  issued 
to  those  who  are  entitled  to  wear  a  brassard  but  who  do  not  wear  a 
uniform.     (See  pars.  542  and  543,  M.  M.  D.) 

(/)  Diagnosis  tags.— On  the  battlefield  diagnosis  tags  are  applied 
to  all  sick,  wounded,  and  dead  and  are  used  in  recording  and  report- 
ing casuahies.     (See  pars.  567  to  574.  M.  M.  D.) 

(g)  List  of  sick  and  tvotinded  (Form  53).— With  the  exceptions 
noted  in  paragraph  575,  M.  M.  D.,  this  form  will  be  used  as  a  sub- 
30 


466  CLERICAL  WORK 

stitute  for  Forms  51,  51a,  51&,  and  52  in  reporting  and  recording  the 
sick  and  wounded  in  the  theater  of  operations. 

(h)  Return  of  casualities  (Form  149,  A.  G.  O.). —  This  report  is 
made  after  every  action  in  which  casuahies  have  occurred,  by  the 
commanding  officer  of  each  independent  organization.  Casualties 
pertaining  to  the  personnel  of  the  organization  making  the  report 
only  should  be  included.  Regimental  surgeons  furnish  regimental 
commanders  with  information  necessary  for  the  preparation  of  the 
report. 

(i)  In  the  case  of  Medical  Department  units  which  have  quarter- 
master accountability  such  additional  records,  reports,  returns,  etc., 
as  are  required  by  the  Quartermaster  Corps  must  be  kept  and  made. 

The  various  blank  forms  for  the  preparation  of  the  papers  re- 
quired by  the  several  departments  concerned  are  enumerated  in 
paragraphs  961  to  965,  M.  M.  D.  They  must  be  obtained  as  indi- 
cated therein  for  time  of  peace  or,  in  the  case  of  troops  in  the  theater 
of  operations,  as  prescribed  in  paragraph  5516^  M.  M.  D. 

Medical  supply  depots  on  the  line  of  communications  will  make 
returns,  reports,  and  records  similar  to  those  of  home  depots.  In 
addition  they  will  make  to  the  surgeon,  base  group,  the  daily  field 
reports  of  sanitary  personnel  and  transportation  required  by  para- 
graph 558,  M.  M.  D. 


PART  XI 

MINOR  SURGERY 


The  noncommissioned  ofBcer  of  the  hospital  corps  must  very 
frequently  act  as  the  surgeon's  assistant,  performing  such  duties 
as  in  civil  life  are  assigned  to  a  physician.  He  may  have  to  take 
entire  charge  of  the  anesthetic,  or  act  as  the  first,  second,  or  other 
assistant.  Indeed,  the  occasions  are  not  infrequent  when  a  small 
detachment  is  in  the  field  without  any  medical  officer,  and  the  non- 
commissioned officer  himself  may  have  to  do  minor  operations  and 
permanently  arrest  hemorrhage. 


CHAPTER  I 

ANESTHESIA,    GENERAL   AND  LOCAL 

'  An  anesthetic  is  an  agent  that  abolishes  sensation.  It  may  be 
general  or  local.  The  former  affects  the  whole  system  and  produces 
unconsciousness  and  muscular  relaxation.  The  latter  affects  only 
the  part  to  which  it  is  applied,  destroying  the  sensation  of  the  local 
nerves. 

The  principal  general  anesthetics  are  ether,  chloroform,  ethyl 
chloride,  and  nitrous-oxide  gas,  the  latter  being  used  almost  exclu- 
sively by  dentists. 

Before  commencing  the  administration  of  any  anesthetic  every- 
thing should  be  made  ready ;  the  patient  should  not  have  had  any 
food,  except  perhaps  a  cup  of  coffee  or  bouillon,  for  five  or  six 
hours  before  commencing  anesthesia.  His  head  should  rest  on  a  low 
pillow  covered  with  a  towel,  and  the  skin  of  the  face,  around  the 
mouth  and  nose,  which  is  liable  to  be  irritated  by  the  anesthetic, 
should  be  protected  by  vaseline. 

On  a  small  table  to  the  right  of  the  anesthetizer  should  be  placed 
the  appropriate  articles,  ether  or  chloroform,  a  screw  gag,  lever 

(467) 


468  MINOR  SURGERY 

gag,  tongue  forceps,  swab-holder  and  swab,  towel,  teaspoon,  sterile 
w^ater,  a  hypodermic  syringe  charged  with  two  milligrammes  of 
strychnine,  hypodermic  tablets  of  morphine,  digitalis,  and  strychnine, 
nitrite  of  amyl  pearls,  vaseline,  and  a  basin  for  vomitus. 

Pure  sulphuric  ether  is  generally  considered  the  safest  and  best 
anesthetic  for  general  purposes.  It  should  be  kept  in  tin  cans  in  a 
cool,  dark  place.  It  is  about  two  and  a  half  times  heavier  than  air 
and  inflammable;  therefore  lights  should  not  be  brought  near  the 
inhaler,  but  gas  jets  four  or  more  feet  from  the  patient's  head  are 
safe.  Throughout  the  anesthesia  the  body  must  be  kept  warmly 
covered. 

Ether  is  now  generally  given  by  the  drop  method  in  the  same 
manner  as  chloroform. 

The  arms  of  the  patient  must  not  be  brought  above  his  head  nor 
allowed  to  hang  over  the  edge  of  the  table,  as  paralysis  has  followed 
the  undue  pressure  in  such  cases;  the  forearms  should  be  flexed 
and  folded  over  the  base  of  the  chest,  being  rolled  in  the  undershirt 
to  confine  them. 

Assistants  must  be  careful  not  to  interfere  with  respiration  by 
leaning  on  the  chest. 

Usually  there  is  a  stage  of  excitement  marked  by  flushed  face, 
increased  heart  action,  some  struggling,  perhaps  tremor  and  general 
rigidity  of  the  body;  all  these  symptoms  are  more  marked  in  alco- 
holics. 

The  state  of  complete  anesthesia  is  marked  by  relaxation  so  that 
the  arm  drops  when  lifted,  snoring  respiration,  and  the  absence  of 
winking  when  the  eyeball  is  touched. 

The  anesthetizer  must  closely  watch  the  pulse,  respiration,  and 
color  of  the  patient,  as  well  as  his  pupils  and  the  conjunctival  reflex. 
In  complete  anesthesia  the  pulse  and  respiration  ratio  should  be 
about  normal,  the  pupils  should  be  contracted  and  should  react  to 
light. 

Danger  signals  are  marked — especially  sudden — weakness  and 
rapidity  of  the  pulse,  stopping  of  respiration,  cyanosis,  dilatation  of 
the  pupils,  and  absence  of  their  reaction  to  light.  The  return  of  the 
conjunctival  reflex  —  wnnking  on  touching  the  eyeball  —  indicates 
that  the  patient  is  "  coming  out  "  of  the  anesthetic. 

Sudden  cessation  of  respiration  is  often  due  to  the  falling  back 
of  the  tongue  over  the  opening  of  the  larynx ;  in  such  a  case  the  lower 


ANESTHESIA,  GENERAL  AND  LOCAL  469 

jaw  should  be  thrown  forward  by  the  fingers  behind  the  angles  of 
the  jaw,  and  if  this  does  not  suffice  the  teeth  must  be  forced  apart, 
and  the  tongue  drawn  forward  with  tongue  forceps  (Figs.  253  and 
254).  If  the  respiration  is  not  at  once  resumed  artificial  respiration 
must  be  resorted  to. 

Failure  of  the  pulse  is  an  indication  for  the  use  of  stimulants 
and  perhaps  discontinuance  of  the  ether. 

Efforts  at  vomiting  may  usually  be  controlled  by  giving  more 
ether,  but  if  it  can  not  be  prevented  the  head  should  be  turned  on  the 
side  to  allow  the  escape  of  the  vomited  matter. 


Fig.  253. —  Pushing  Forward  the  Jaw  for  Treatment  of  Asphyxia. 

Accumulation  of  mucus  in  the  throat  should  be  removed  by  a 
sponge  on  a  sponge-holder. 

Chloroform  is  given  by  the  open  or  "  drop  method  "  so  as  to  secure 
a  free  admixture  of  air;  it  is  four  times  as  heavy  as  air  and  not 
inflammable. 

The  Esmarch  inhaler  is  supplied  in  the  army,  but  a  small  hand- 
kerchief or  a  piece  of  lint  folded  once  answers  the  purpose  very 
well.  In  the  absence  of  a  chloroform  bottle  with  dropping  attach- 
ment, one  can  be  extemporized  by  cutting  a  V-shaped  trough  on 
the  opposite  sides  of  the  cork. 

The  same  precautions  must  be  observed  as  in  ether  anesthetic, 
remembering  that  while  ether  is  a  heart  stimulant  chloroform  is  a 
heart  depressant  and  that  the  great  danger  with  chloroform  is  heart 
failure. 


470 


MINOR  SURGERY 


A  few  drops  of  chloroform  are  placed  on  the  inhaler,  which  is 
at  first  held  some  distance  from  the  mouth  and  gradually  approached, 
but  never  brought  close  enough  to  exclude  the  air.  A  few  drops  are 
added  from  time  to  time  as  the  chloroform  evaporates,  but  progress 
sively  less  after  anesthesia  becomes  complete. 

The  relative  advantages  of  ether  and  chloroform  may  be  summed 
up  as  follows :  Ether  is  slower,  requires  much  larger  quantities, 
is  less  pleasant  to  take,  causes  much  more  irritation  and  costs  more ; 
it  is  usually  safer. 

In  the  field  chloroform  is  preferable  because  of  the  much  smaller 


Fig.  254. —  Drawing  Out  the  Tongue  for  Treatment  of  Asphyxia. 


quantity  which  it  is  required  to  transport  and  the  shorter  time  neces- 
sary for  anesthesia. 

In  the  tropics  ether,  on  account  of  its  greater  volatility,  is  hard  to 
keep,  and  much  more  is  required  to  produce  anesthesia. 

Local  anesthesia  is  very  useful  in  opening  boils  and  abscesses, 
splitting  inflammed  piles,  and  in  any  operations  of  the  fingers  or  toes. 

There  are  two  general  classes  of  local  anesthetics,  those  which 
destroy  the  sensibility  of  the  nerves  by  freezing  and  those  which 
must  be  injected  hypodermically  into  the  part. 

Of  the  freezing  agents  the  best  is  ethyl  chloride,  which  is  fur- 
nished in  metallic  tubes  arranged  so  as  to  throw  a  fine  spray  upon 
the  part;  the  tube  should  be  held  at  a  distance  of  ten  or  twelve 
inches,  and  when  the  part  suddenly  turns  white  sensation  is  de- 
stroyed. The  objection  to  freezing  agents  is  that  the  pain  in  freez- 
ing and  thawing  is  almost  as  great  as  it  would  have  been  from  the 
incision,  and  that  sloughing  may  follow  undue  freezing. 


ANESTHESIA,  GENERAL  AND  LOCAL  471 

The  most  generally  useful  local  anesthetic  is  cocaine  hydro- 
chloride in  solutions  of  two  to  ten  per  cent  in  water.  In  the  mucous 
membrances  the  anesthesia  is  produced  by  the  surface  application, 
but  in  other  tissues  it  must  be  used  hypodermically.  The  anes- 
thesia commences  in  a  minute  or  two  and  lasts  about  fifteen  minutes. 
If  the  cocaine  is  confined  to  the  part  so  that  the  blood  can  not  carry 
it  away,  as  when  a  ligature  is  thrown  around  the  "base  of  a  finger 
or  toe,  the  effect  may  be  maintained  indefinitely. 

The  objection  to  cocaine  is  its  depressing  action  on  the  heart 
and  the  danger  of  contracting  the  habit.  The  maximum  quantity 
to  be  used  subcutaneously  is  thirty  to  forty  milligrammes.  The  solu- 
tions do  not  keep  vyell  and  should  always  be  freshly  prepared  and 
made  with  sterile  water;  the  solutions  themselves  can 'not  be  ster- 
ilized by  heat,  as  heat  decomposes  the  cocaine. 

Eucaine-B  is  sometimes  used  as  a  substitute  for  cocaine,  in  solu- 
tions of  the  same  strength  and  in  the  same  manner.  It  is.  slower 
in  its  action  than  cocaine,  but  not  so  depressing  to  the  heart,  its 
effects  last  longer,  and  its  efficiency  is  not  impaired  by  heat  sterili- 
zation. 

In  Schleich's  method  very  dilute  solutions  are  used,  but  the  tis- 
sues, especially  the  skin,  are  infiltrated  with  them..  Schleich  used 
three  solutions  of  different  strengths.  The  medium  solution  is  pre- 
pared as  follows : 


1$  Cocain,  hydrochloric!    . . 
Morphin,   hydrochlorid 

Sodii   chlorid    

Aq.    destill    


100 
02S 
200 
000 


Sterilize  solution  and  add  gtt.  ij.  of  five-per-cent  phenol. 

The  stronger  solution  contains  twice  as  much  cocaine  and  the 
weaker  one-tenth  as  much  cocaine  and  one-fifth  as  much  morphine. 

To  anesthetize  the  skin  it  is  necessary  to  inject  the  solution  into 
and  under  it. 

In  spinal  anesthesia  a  solution  of  cocaine  or  eucaine  is  injected 
into  the  spinal  canal  between  the  fourth  and  fifth  lumbar  vertebrae, 
after  withdrawing  a  small  portion  of  spinal  fluid ;  anesthesia  with- 
out loss  of  consciousness  is  produced  in  all  parts  of  the  body  below 
the  seat  of  the  injection. 

The  method  has  not  met  with  general  acceptance  on  account  of 
its  uncertainty,  and  because  of  the  severe  and  even  fatal  accidents 
which  have  attended  its  use. 


CHAPTER  II 

ASSISTING  AT   OPERATIONS 

Minor  Operations 

In  an  operation  the  duty  of  the  noncommissioned  officer  may- 
be to  prepare  and  hand  instruments,  to  sponge,  to  assist  in  the  opera- 
tion, or  to  help  in  all  three  ways.  He  must  watch  the  operation 
and  operator  closely  and  endeavor  to  anticipate  the  wants  of  the 
surgeon. 

The  sterilized  instruments  should  all  be  laid  out  beforehand, 
as  much  as  possible  in  the  order  in  which  they  will  be  needed  and 
those  of  the  same  kind  grouped  together.  Needles  should  be  placed 
in  a  shallow  glass  dish  of  alcohol  and  a  few  should  always  be 
threaded  ready  for  use.  In  threading,  the  suture  should  be  held  in 
the  right  hand  and  the  needle  held  in  the  left  and  passed  over  it; 
catgut  or  tendon  may  be  cut  obliquely  and  flattened  between  the 
handles  of  a  pair  of  scissors  to  facilitate  threading,  but  silk  must 
always  be  cut  square  across  to  avoid  unraveling. 

Iodoform  dusters  or  other  unsterilized  articles  must  be  wrapped 
in  sterile  gauze. 

When  the  sutures  are  in  sealed  glass  tubes,  the  tubes  must  be 
sterilized  in  an  antiseptic  solution,  broken  in  a  sterile  towel,  and  the 
contents  dropped  in  alcohol. 

Ligatures  should  be  about  nine  inches  long  and  sutures  twelve 
inches. 

A  complete  dressing  should  be  ready  in  a  sterilized  towel. 

When  the  intestines  are  to  be  exposed  hot  towels  will  be  needed; 
to  have  them  ready,  sterile  water  is  kept  hot  and  the  towels  are 
dipped  in  when  necessary. 

Rubber  drains  usually  have  a  safety  pin  passed  through  one  end 
to  prevent  them  from  slipping  in ;  gauze-wick  drains  are  prepared 
by  rolling  a  narrow  strip  of  gauze  into  a  wick  about  the  size  of  a 
cigarette  and  covering  it  with  a  layer  of  rubber  tissue. 

Instruments  should  always  be  handed  to  the  operator  with  the 

(472) 


ASSISTING  AT  OPERATIONS 


473 


handle  toward  his  hand,  and  in  such  a  position  that  they  may  be 
used  at  once  without  loss  of  time;  they  should  not  be  allowed  to 
accumulate  unnecessarily  upon  the  patient's  body,  and  soiled  and 
bloody  instruments  should  be  replaced  by  clean  ones. 

Sponging  must  be  done  quickly  in  the  intervals  of  the  surgeon's 
work,  the  sponge  should  be  used  with  a  firm  wiping  movement  in 
the  direction  from  the  bottom  of  the  wound  toward  the  surface. 

Retractors  are  held  in  such  a  position  that  they  and  the  hands 
of  the  assistant  may  be  as  little  in  the  way  as  possible;  sharp 
retractors  should  be  used  with  care. 

In  suturing,  the  needle  properly  threaded  and  held  in  the  bite  of 
the  forceps  should  be  handed  to  the  surgeon;  the  assistant  then 


/-^'^ 


m- 


Fig.    235- —  The    Interrupted 
Suture. 


Fig.    256. —  The   Continuous    Suture. 


holds  the  edges  of  the  wound  in  the  proper  position  for  suturing, 
and  is  ready  with  scissors  to  divide  the  sutures  at  the  proper  time. 

When  there  is  no  surgeon  present  with  the  troops  and  none  is 
available,  the  senior  noncommissioned  officer  of  the  hospital  corps 
detachment  must  himself  undertake  necessary  minor  operations. 

Wounds.  Clean,  incised  wounds,  the  edges  of  which  can  not  be 
brought  together  by  the  dressing  and  bandage,  should  be  sutured 
or  sewed  up.  Silkworm  gut,  silk,  or  catgut  may  be  used,  the  pref- 
erence being  in  the  order  named ;  sutures  of  the  first  two  materials 
must  be  taken  out  after  four  or  five  days ;  catgut  will  be  absorbed. 

Sutures  may  be  interrupted  or  continuous.  In  the  interrupted 
suture  (Fig.  255)  the  needle  is  passed  through  the  skin  and  sub- 
cutaneous tissues  about  an  eighth  of  an  inch  from  the  edge  of  the 
wound,  and  then  tied  with  a  reef  knot;  care  should  be  taken  not 
to  draw  the  suture  tight  enough  to  contract  and  pucker  the  skin ;  the 


474  MINOR  SURGERY 

remaining  sutures  are  then  placed  about  a  quarter  of  an  inch  apart. 
The  interrupted  suture  is  the  one  ordinarily  used. 

The  contimwus  suture  (Fig.  256)  is  applied  by  continuously  pass- 
ing the  needle  through  the  skin  without  cutting  the  thread. 

If  there  is  any  doubt  about  the  cleanliness  of  the  wound  or  if 
there  is  much  oozing  from  it,  the  lower  angle  should  be  left  open 
for  drainage. 

If  the  wound  is  in  a  hairy  part  the  hair  must  be  clipped  close, 
and  the  skin  about  the  wound  paitited  with  tincture  of  iodine.  The 
same  precautions  as  to  instruments  and  the  hands  are  observed  as  in 
operation  wounds.  If  the  wound  is  small  and  not  infected,  all  the 
dressing  needed  may  be  a  few  shreds  of  cotton  sprinkled  with 
iodoform  and  held  in  place  by  collodion. 

Should  the,  wound  contain  dirt  or  other  foreign  bodies  they 
should  be  washed  away  with  sterile  water  or  removed  with  sterile 
forceps ;  as  such  wounds  are  sure  to  be  infected  a  free  opening  must 
be  left  for  drainage. 

Contused  or  lacerated  wounds,  unless  the  contusion  is  very  severe, 
should  also  be  sutured,  but  not  so  closely  as  incised  wounds  nor 
should  the  sutures  be  made  so  tight,  as  much  tension  and  swelling 
art  apt  to  ensue. 

Before  any  wound  is  sutured  all  bleeding  should  be  controlled 
permanently;  if  the  bleeding  is  capillary  this  may  be  done  by  ex- 
posure to  the  air,  hot  water,  or  pressure;  if  the  hemorrhage  is  from 
an  artery  the  spurting  point  must  be  found,  seized  with  a  pair  of 
artery  forceps  and  twisted,  or  a  catgut  ligature  may  be  slipped  over 
the  forceps  and  the  vessel  tied. 

In  furuncle  or  boil  there  is  a  hard,  painful  swelling  with  a  cen- 
tral pustule  overlying  a  small  slough  or  core.  The  occurrence  of 
a  number  of  boils  in  the  same  neighborhood  is  usually  due  to  infec- 
tion from  the  first  one. 

If  a  boil  is  seen  early  enough  it  may  sometimes  be  aborted 
by  dipping  a  sharpened  stick  in  pure  phenol  and  carrying  it  down 
into  the  core  through  the  central  pustule.  If  seen  later  the  only 
thing  which  will  give  prompt  relief  is  a  free  cross  cut.  the  cuts  must 
be  deep  enough  and  long  enough  to  go  entirely  through  the  hard- 
ened part,  otherwise  they  will  fail.  Use  a  very  sharp  scalpel  and 
make  each  cut  at  one  quick  sharp  stroke.  Local  anesthesia  may 
be    used.      After    the    incision    apply    wet    antiseptic    dressings. 


ASSISTING  AT  OPERATIONS  475 

To  prevent  a  succession  of  boils  the  skin  about  the  first  one 
should  be  kept  thoroughly  clean  and  disinfected,  the  hands  should 
be  disinfected,  and  the  underclothing  frequently  changed. 

Carbuncles  differ  from  furuncles  in  being  more  extensive  and 
severe  and  in  having  several  openings  or  heads;  the  treatment  is  the 
same. 

Felon  is  an  abscess  below  the  fascia  or  periosteum  in  the  end 
of  the  finger;  it  is  due  to  infection  through  a  hang-nail  or  some  small 
wound.  The  tendency  is  to  spread  deeply  and  not  to  come  to  the 
surface.  The  pain  is  intense  and  throbbing.  The  treatment  con- 
sists in  making  a  free  incision  down  to  the  bone  and  gives  prompt 
relief;  unless  this  is  done  necrosis  of  the  bone  may  result.  Apply 
a  wet  dressing. 

Abscesses  when  near  the  surface  may  be  detected  by  the  soft 
fluctuating  center  surrounded  by  a  hard  ring.  They  should  be 
opened  with  a  sharp-pointed  curved  bistoury  thrust  through  the  skin 
over  the  top  of  the  abscess  and  cutting  from  within  outward.  After 
opening,  a  drainage  tube  should  be  inserted  and  a  wet  dressing 
applied;  the  drainage  tube  may  be  left  in  as  long  as  pus  continues 
to  flow. 

Alveolar  abscess  or  gum  boil  is  an  abscess  starting. at  the  root 
of  the  teeth  and  usually  making  its  way  out  at  the  junction  of  the 
cheek  and  gum.  The  symptoms  are  toothache,  pain,  and  often 
great  swelling  of  the  face;  on  opening  the  mouth  pressure  on  suc- 
cessive teeth  will  show  by  the  pain  produced  which  one  is  affected, 
and  often  swelling  may  be  seen  at  the  base  of  the  gum.  With  a 
straight  bistoury  a  puncture  should  be  made  straight  downward  at 
the  base  of  the  gum  and  over  the  softest  point. 

Ulcers  are  what  are  commonly  called  sores.  They  require  wet 
antiseptic  dressings  and  often  the  support  of  a  rubber  bandage. 

An  inflamed  hemorrhoid  or  pile  is  an  extremely  painful  affec- 
tion which  may  be  promptly  relieved  by  a  very  simple  operation. 
The  patient  complains  of  a  painful  swelling  at  the  anus,  and  on 
examination  a  red  or  purple,  hard  swelling  is  found ;  this  is  due  to 
the  formation  of  a  blood-clot  in  the  pile.  With  or  without  cocaine 
anesthesia  run  a  sharp  curved  bistoury  through  the  base  of  the 
tumor  and  cut  from  within  outward;  this  frees  the  clot  and  the 
pain  now  ceases. 


CHAPTER  III 

MINOR  OPERATIONS,   CONTINUED 

Subcutaneous  saline  infusions  are  frequently  given  in  hospitals 
for  shock,  hemorrhage,  suppression  of  urine,  and  other  conditions. 
The  appliances  needed  are  a  graduated  infusion  bottle  or  a  foun- 
tain syringe,  a  large-size  aspirating  needle,  and  sterile  normal  saline 
solution  at  a  temperature  of  105°  to  110°  Fahrenheit.  In  the 
absence  of  an  infusion  bottle  or  fountain  syringe  a  large  funnel 
may  be  used;  a  piece  of  glass  tubing  inserted  in  the  length  of 
the  rubber  tubing  will  enable  the  operator  to  observe  the  flow  of 
the  infusion.  All  the  appliances  must  be  clean  and  freshly  sterilized 
by  boiling. 

The  bottle  or  other  container  Js  hung  up  at  a  height  of  about  three 
feet  above  the  patient's  body,  and  while  the  solution  is  flowing 
from  the  needle  it  is  thrust  quickly  into  the  subcutaneous  tissues 
and  held  there  (Fig.  257). 

The  part  selected  is  usually  the  back  between  the  shoulders, 
the  axilla,  or  the  buttock.  The  hands  of  the  operator  and  the  site 
of  the  operation  are  carefully  disinfected  in  the  usual  manner. 

The  amount  injected  is  usually  one  or  two  pints  distributed  in 
two  or  three  places ;  it  will  require  about  half  an  hour  for  the  fluid 
to  enter  and  during  this  time  the  temperature  of  the  solution  must 
be  maintained. 

After  the  withdrawal  of  the  needle  the  skin  of  the  puncture  is 
pinched  up,  dried  with  a  gauze  sponge,  and  dabbed  with  collodion, 
a  small  gauze  dressing  is  then  applied. 

Rectal  continuous  saline  infusions  by  the  drop  method  have  re- 
placed to  a  large  extent  the  subcutaneous  infusions.  Any  ordinary 
irrigating  apparatus  may  be  used  with  a  special  nozzle  and  cut-off. 

Intravenous  saline  infusions  are  done  when  quick  action  is 
required. 

The  median  basilic  or  medium  cephalic  vein  at  the  bend  of  the 

(476) 


MINOR  OPERATIONS,  CONTINUED 


477 


elbow  is  exposed  by  a  short  incision,  after  which  an  aspirating 
needle  may  be  inserted  direct  or  the  vein  opened  and  a  canula  tied 
in ;  when  a  needle  is  used  the  preliminary  incision  is  usually  small. 
The  danger  is  the  introduction  of  air  or  any  foreign  body  into  the 
vein  which  might  cause  embolism  or  death. 

Intravenous  injections  of  salvarsan  and  neosalvarscm  for  syphilis 
are  given  in  the  same  way  as  saline  infusions  with  the  use  of  needle 
instead  of  canula.  The  injection  tube  and  needle  should  be  filled 
with  salt  solution  before  the  prepared  solution  is  poured  into  the 
reservoir,  so  that  salt  solution  only  will  escape  into  the  tissues  if  the 


If  \ 


Fig.  257. —  Subcutaneous  Saline  Injection. 


vein  is  missed  on  the  first  trial.  In  most  cases  it  is  unnecessary  to 
expose  a  vein  by  incision. 

Injections  of  antitoxin  for  diphtheria  are  usually  given  between 
the  shoulders;  the  procedure  is  the  same  as  for  hypodermic  injec-' 
tions,  the  syringe  used  being  of  the  same  type,  only  much  larger. 
The  usual  antiseptic  precautions  are  observed. 

SyphUis  is  now  usually  treated  by  intravenous  injections  of  sal- 
varsan. Mercury  is  often  used  in  conjunction  with  the  salvarsan  and 
preferably  by  subcutaneous  injections  of  metallic  mercury  m  the 


478  MINOR  SURGERY 

form  of  "gray  oil."  The  appliances  needed  are  a  hypodermic 
syringe  with  a  large  caliber  needle,  the  gray  oil,  an  alcohol  lamp,  and 
collodion,  or  adhesive  plaster. 

The  injections  are  usually  made  in  a  vertical  line  on  either  side 
of  the  spinal  column  and  about  an  inch  and  a  half  from  it  aiid  an 
inch  and  a  half  apart.  The  syringe  used  should  preferably  be  of 
a  half  or  one  Cc.  capacity,  and^graduated  in  fiftieths  of  a  cubic  cen- 
timeter. 

The  needles  should  screw  on,  as  friction  needles  are  forced  off 
by  the  psessure  necessary  to  push  out  the  thick  preparation  of  mer- 
cury. After  the  preliminary  sterilization  the  syringe  and  needles 
are  kept  immersed  in  a  wide-mouth  bottle  of  liquid  petrolatum. 
The  gray  oil  is  kept  in  a  wide-mouth  bottle  of  about  fifteen  Cc. 
capacity,  and  the  bottle  is  protected  from  dust  and  dirt  in  a  tin  box ; 
the  box  is  kept  in  a  cool  place,  preferably  on  ice. 

The  skin  of  the  patient  and  the  hands  of  the  operator  having 
been  disinfected,  the  gray  oil  is  warmed  over  the  alcohol  lamp  until 
it  will  just  flow  freely,  and  then  drawn  into  the  syringe.  The  syringe 
is  next  turned  point  up,  and  the  piston  compressed  until  a  drop  of 
gray  oil  emerges;  the  set-screw  of  the  piston  rod  is  so  placed  that 
the  syringe  can  only  deliver  the  required  dose,  usually  0.05  Cc. ; 
a  fold  of  skin  is  pinched  up  vertically  between  the  thumb  and  finger, 
the  needle  plunged  in  obliquely,  and  the  dose  is  given.  The  puncture 
is  compressed  by  the  finger  for  a  moment  and  then  sealed  with 
collodion  or  adhesive  plaster.  No  rubbing  of  the  spot  is  necessary 
or  desirable.  A  ten-per-cent  suspension  of  basic  salicylate  of  mer- 
cury in  liquid  petrolatum  is  frequently  used  instead  of  gray  oil. 

Acupuncture  is  the  process  of  puncturing  the  skin  and  cellular 
tissues  with  hypodermic  or  other  needles  for  the  relief  of  oedema. 

The  skin  and  needles  are  sterilized,  and  the  former  protected  with 
gauze  while  the  fluid  is  draii;ing. 

Aspiration  consists  in  the  withdrawal  of  fluid  from  a  cavity  which 
may  be  the  abdomen,  thorax,  or  pericardium. 

Aspiration  of  the  abdomen  or  paracentesis  is  usually  done  with  a 
trocar  and  canula ;  after  preparation  as  for  any  surgical  operation, 
make  a  small  incision  in  the  skin  and  insert  the  trocar  and  canula. 

Aspiration  of  the  chest  is  required  by  an  accumulation  of  serum 
therein  known  as  hydrothorax,  or  if  purulent  empyema,  it  is  done 
with  an  aspirator. 


MINOR  OPERATIONS,  CONTINUED 


479 


For  aspiration  of  the  pericardium  an  exploring  syringe  or  hypo- 
dermic is  used. 

Lumbar  puncture  is  done  for  purposes  of  diagnosis  or  to  relieve 
pressure  in  the  spinal  canal,  the  patient  is  brought  to  the  edge 
.of  the  bed  with  his  knees  well  drawn  up  and  his  head  and  shoulders 
well  bent  forward  to  separate  the  vertebrae.  The  puncture  is 
usually  made  between  the  fourth  and  fifty  lumbar. 


Fig.  258. — Washing  Out  the  Stomach.    First  step. 


Fig.  259. — Washing  Out  the  Stomach. 
Second  step. 


Blood  Specimens  are  frequently  required  for  (i)  microscopical 
examination,  (2)  Haemoglobin  estimates,  (3)  counts,  and  (4) 
cultures. 

For  (i)  and  (2)  a  drop  is  taken  from  a  needle  puncture  of  the 
lobe  of  ear;  for  microscopical  examination  it  is  collected  on  a  clean 
cover  glass. 

For  counts  the  blood  is  also  taken  from  the  ear-lobe,  but  with 
a  special  instrument  known  as  the  haemocytometer. 

For  blood  cultures  about  10  Cc.  must  be  taken  from  the  median 
basilic  vein  at  the  head  of  the  elbow.  After  the  usual  surgical  pre- 
cautions, a  ligature  is  bound  about  the  arm  above  the  elbow  tight 
enough  to  cause  the  veins  to  swell  up  but  not  tight  enough  to  stop 


480 


MINOR  SURGERY 


the  pulse;  tlie  hypodermic  needle  is  then  pushed  directly  into  the 
vein. 

The  stomach  tube  is  used  to  remove  poisons  from  the  stomach, 
to  wash  it  out,  and  to  introduce  food-gavage. 

For  the  first-named  purpose  a  tube  about  five  feet  long  is  re- 
quired, for  the  last  purpose  one  two  and  a  half  feet  long  will  suffice. 
The  tube  is  usually  lengthened  by  a  piece  of  rubber  tubing  connected 
by  a  glass  tube. 

The  patient  sits  in  a  chair  with  his  head  thrown  back;  the  tube 
having  been  warmed  and  dipped  in  glycerin  is  passed,   together 


Fig.  260. —  Introduction  of  Metallic  Catheter.     First  step. 


with  the  operator's  left  forefinger,  into  the  back  of  the  throat ;  the 
finger  guides  the  tube  past  the  epiglottis  to  the  back  of  the  pharynx, 
whence  it  is  pushed  slowly  and  gently  into  the  stomach,  its  passage 
being  aided  by  attempts  to  swallow. 

Sometimes  the  patient  prefers  to  take  the  tube  into  his  mouth, 
swallow  the  end  and  then  push  it  down  himself. 

Food  is  introduced  through  a  funnel  in  the  end  of  the  tube. 
To  remove  poisons  or  wash  out  the  stomach,  siphonage  must  be 


MINOR  OPERATIONS,  CONTINUED  481 

secured;  to  do  this  pour  water  into  the  funnel  held  above  the 
patient's  head  until  the  tube  and  funnel  are  full ;  then  before  all  the 
water  has  run  out  of  the  funnel  lower  it  below  the  level  of  the  stom- 
ach; this  movement  may  be  repeated  as  often  as  necessary  (Figs. 
250  and  259). 

When  the  patient  is  unconscious  the  operator  must  be  sure  before 
he  introduces  any  fluid  that  the  tube  has  not  entered  the  patient's 
larynx. 

Sometimes  it  is  desired  to  obtain  a  sample  of  the  stomach  contents 
without  admixture  with  water.     To  do  this,  introduce  the  stomach 


Fig.  261. —  Introduction  of  Metallic  Catheter.     Second  step. 

tube  in  the  manner  just  described,  lower  the  funnel  over  the  basin, 
have  the  patient  lean  forward  and  strain  a  little,  then  gently  press 
the  stomach  to  express  the  contents. 

In  forced  feeding,  when  the  patient  resists,  it  is  better  to  pass  a 
smaller  tube  along  the  floor  of  the  nose  and  thence  into  the  pharynx. 

To  introduce  a  metallic  catheter  or  sound  into  the  bladder,  place 
the  patient  on  his  back  with  the  shoulders  raised,  and  the  legs  drawn 
up  and  rotated  slightly  outward  so  as  to  relax  the  abdominal  mus- 
cles ;  having  sterilized,  warmed,  and  lubricated  the  instrument,  stand 
on  the  left  side  of  the  patient,  grasp  the  penis  in  the  fingers  of  the 
left  hand  and  draw  it  vertically  upward  with  its  back  toward  the 
abdomen,  hold  the  catheter  lightly  in  the  right  hand  and  introduce 
the  tip  into  the  meatus.  The  instrument  and  penis  should  now  be 
carried  close  to  the  body  over  and  parallel  with  the  groin  (Fig.  260). 

The  penis  is  then  drawn  up  over  the  instrument  which  is  at  the 
31 


482  MINOR  SURGERY 

same  time  pushed  gently  in  or  allowed  to  pass  by  its  own  weight; 
at  the  same  time  the  handle  of  the  catheter  is  slowly  carried  toward 
the  median  line  and,  after  about  four  or  five  inches  have  disappeared 
in  the  urethra,  elevated  to  the  vertical  position,  when,  the  tip  pass- 
ing under  the  arch  of  the  pubis,  the  handle  is  depressed  between  the 
thighs  (Fig.  261).  No  force  should  be  used  under  any  circum- 
stances. 

Hernia  or  rupture  is  a  condition  m  which  some  part  of  the  con- 
tents of  the  abdomen,  particularly  the  intestine,  escapes  and  forms 
an  external  tumor.  It  is  usually  caused  by  violent  muscular  effort 
or  straining,  and  is  especially  apt  to  occur  in  the  tropics  as  a  result 
of  loss  of  flesh  and  general  muscular  relaxation.  Though  it 
develops  gradually,  its  appearance  is  often  sudden. 

Inguinal  hernia  appears  as  a  swelling  just  above  the  fold  of  the 
groin,  which  may  pass  on  down  alongside  the  testicle,  becoming 
scrotal. 

In  femoral  hernia  the  swelling  is  just  below  the  fold  of  the  groin, 
and  usually  much  smaller  than  in  the  inguinal  form. 

The  swelling  is  soft  and  elastic  and  at  first  goes  back  when  the 
patient  lies  down,  or  can  be  pushed  back;  sometimes  it  will  not  go 
back  and  is  then  said  to  be  irreducible ;  if  the  hernia  becomes  so 
tightly  caught  in  the  ring  through  which  it  passes  that  the  circula- 
tion is  arrested  it  is  said  to  be  strangulated. 

The  temporary  treatment  of  a  hernia  consists  in  the  application 
of  a  truss.  Before  the  truss  is  applied,  however,  the  hernia  must 
be  put  back  or  reduced;  if  this  is  not  done  the  trusss  will  press  on 
the  delicate  intestine  and  cause  severe  pain  and  inflammation. 

To  reduce  a  hernia  that  will  not  go  back  of  itself,  place  the 
patient  on  his  back  with  a  pillow  under  his  hips,  and  the  hips  and 
knees  flexed,  and  tell  him  to  breathe  quietly  through  the  mouth,  and 
not  to  strain.  Then  grasp  the  tumor  with  the  fingers  and  squeeze 
it  gently  as  you  would  a  sponge,  in  a  direction  upward,  backward, 
and  outward;  a  sudden  slip  will  be  felt  as  the  intestine  returns. 
The  truss  should  now  be  applied  with  the  patient  lying  down. 

A  truss  consists  of  a  pad  to  cover  the  ring  and  inguinal  canal,  and 
a  spring  to  make  the  pressure  and  hold  the  pad  in  place;  there  is 
usually  also  a  strap  from  the  end  of  the  spring  back  to  the  pad  and 
sometimes  also  a  perineal  strap  for  additional  security  in  large 
hernias.     After  a  truss  is  adjusted,  its  efficiency  should  be  tested  by 


MINOR  OPERATIONS,  CONTINUED  483 

seeing  whether  it  will  hold  up  the  hernia  when  the  patient  stands, 
sits,  lies  down,  bends  over,  descends  stairs,  etc. 

To  measure  for  a  truss  place  the  end  of  the  tape  over  the  point 
where  the  hernia  escapes,  and  carry  it  around  the  pelvis  midway 
between  the  anterior  superior  spine  of  the  ilium  and  the  great 
trochanter,  and  back  to  the  starting  point. 

Toothache:  When  there  is  a  cavity  it  should  be  cleaned  out  with 
a  little  absorbent  cotton  on  the  end  of  a  probe  or  match,  and  the 
cavity  then  plugged  with  a  bit  of  cotton  dipped  in  phenol,  creosote, 
or  oil  of  cloves. 

The  tooth  should  not  be  extracted  unless  there  is  no  chance  of 
obtaining  the  services  of  a  dentist  for  a  considerable  time  and  mean- 
while the  pain  is  unbearable. 

To  extract  a  tooth  see  that  a  forceps  is  selected  which  is  adapted 
to  the  particular  tooth ;  in  the  sets  of  forceps  furnished  the  army 
the  particular  forceps  for  each  tooth  is  indicated  on  a  card.  For- 
ceps of  which  the  bite  has  a  plain  curve  on  each  side  are  adapted 
to  teeth  with  a  single  root,  such  as  the  incisors  and  canines ;  those 
of  which  the  bite  has  a  projection  on  the  outer  side  are  for  the  upper 
molars,  the  projections  being  intended  to  fit  between  the  outer  roots; 
and  those  with  a  projection  on  both  sides  are  for  the  lower  molars. 

The  gum  should  be  separated  from  the  neck  of  the  tooth  with 
a  lancet,  and  the  forceps  pushed  down  between  the  gum  and  the 
tooth  until  they  reach  but  do  not  grasp  the  border  of  the  alveolus. 
In  order  to  avoid  breaking  off  the  crown,  the  pressure  of  the  forceps 
must  be  only  sufficient  to  keep  them  from  slipping.  The  tooth  is 
then  loosened  a  little  by  a  rotary  motion  for  the  incisors  and  canines, 
and  an  inward  and  outward  rocking  motion  for  the  other  teeth, 
and  extracted  by  a  steadily  increasing  pull  as  nearly  as  possible  in 
the  direction  of  the  axis  of  the  tooth. 

The  head  and  jaw  of  the  patient  should  be  steadied  by  the  left 
arm  and  fingers  of  the  operator. 

Two  kinds  of  electric  batteries  are  usually  furnished  in  the  army 
medical  department;  a  galvanic  or  continuous-current  battery,  and 
a  faradic  or  interrupted-current  apparatus ;  sometimes  the  two  are 
combined. 

To  care  for  batteries  properly  it  is  necessary  that  their  mechan- 
ism should  be  studied.     After  use  the  elements  or  poles  should 


484  MINOR  SURGERY 

always  be  lifted  out  of  the  liquid,  and  care  should  be  taken  not  to 
spill  the  liquid  in  handling. 

With  dry-cell  batteries  it  is  only  necessary  to  see  that  the  circuit 
is  open  when  the  battery  is  not  in  use,  but  electrodes  should  be 
dried  or  wrapped  in  some  protective  before  they  are  put  away  lest 
they  cause  swelling  of  the  box  or  rusting  of  the  connections. 

The  essential  parts  of  a  galvanic  battery  are  the  cells  which  con- 
tain the  liquid,  the  elements  which  dip  into  the  liquid,  the  cords 
which  conduct  the  electricity,  and  the  electrodes,  usually  covered 
with  sponges,  through  which  the  electricity  is  applied;  faradic  bat- 
teries have  in  addition  a  coil  and  an  interrupter. 

The  sponges  should  be  well  moistened  with  water  before  use. 

To  exercise  muscles  in  paralysis  the  faradic  current  is  usually 
given  about  ten  minutes  at  a  time.  One  of  the  moistened  sponges 
is  placed  at  any  part  of  the  limb  and  the  other  is  moved  about  with 
a  massaging  motion ;  the  skin  also  should  be  well  moistened. 

The  galvanic  current  is  given  as  directed  by  the  surgeon. 


CHAPTER   IV 

ADHESIVE  PLASTER,    STRAPS   AND   STRAPPING 

As  many  of  the  uses  of  adhesive  plaster  are  so  important,  it  is 
thought  best  to  devote  a  chapter  of  minor  surgery  to  a  detailed 
consideration  of  its  various  applications. 

To  hold  splints  in  place,  especially  in  the  upper  extremity,  it  is 
much  superior  to  bandages,  as  it  allows  the  fractured  parts  to  be 


Fig.  262. —  Application  of  Adhesive-Plaster  Strips  to  Retain  Splints. 

seen;  for  this  purpose  two  or  three  strips  about  an  inch  wide  are 
used,  and  applied  as  shown  in  Fig,  262. 

In  the  lower  extremity  webbing  straps  with  buckles  are  better 
than  adhesive  straps  to  hold  the  splints  in  position  but  the  adhesive 
plaster  is  used  for  purposes  of  extension  in  fractures  of  the  thigh. 
For  this  purpose  there  should  be  provided  two  strips  of  plaster, 
each  two  inches  wide  and  long  enough  to  reach  from  the  seat  of  the 
fracture  to  the  malleolus;  to  each  strip  is  sewed  a  webbing  strap 
of  the  same  width  as  the  paster  and  six  inches  long;  three  strips, 
each  an  inch  and  a  half  wide  and  long  enough  to  encircle  the  limb, 

(485) 


486  MINOR  SURGERY 

just  above  the  malleoli,  just  above  the  knee,  and  just  below  the 
fracture  respectively;  and  two  strips  an  inch  and  a  half  wide,  and 
long  enough  to  encircle  the  limb  spirally  from  just  above  the  mal- 
leoli to  just  below  the  fracture.  After  the  limb  has  been  washed, 
sliaved,  and  dried,  the  first  two  straps  are  applied  to  the  middle  of 
each  side  of  the  limb  from  just  below  the  fracture  to  the  malleoli; 
then  the  last  two  straps  are  applied  spirally  in  opposite  directions 
to  keep  the  first  from  slipping,  and  lastly  the  three  remaining  straps 
are  applied  in  a  circular  manner  as  indicated  (Fig.  263).  A  band- 
age is  applied  over  all. 

A   spreader  of  wood,   about  two   inches   wide   and   sufficiently 
long  to  clear  the  malleoli,  is  attached  to  the  webbing  straps;  the 


Fig,  263. —  Strapping  for  Extension  in  Fracture  of  the  Thigh. 

spreader  has  a  hole  in  the  middle  through  which  passes  a  cord 
which  plays  over  a  pulley ;  to  the  outer  end  of  the  cord  is  attached 
a  weight. 

In  fractures  of  the  ribs  a  broad  swathe  of  plaster  is  used,  wide 
enough  to  extend  about  six  inches  on  each  side  of  the  fracture  and 
long  enough  to  reach  three-fourths  of  the  distance  around  the  chest 
(Fig.  264). 

The  patient  standing  or  sitting,  with  his  hands  on  top  of  his 
head,  one  end  of  the  swathe  is  fastened  just  over  the  spinal  column ; 
with  the  other  end  in  his  hands  the  surgeon  walks  around  the  patient 
applying  the  swathe  smoothly  and  very  firmly.  Or  strips  of  plaster 
about  four  inches  wide  may  be  used,  each  strip  overlapping  the  pre- 
vious one  about  one-third. 

In  fracture  of  the  clavicle  a  Sayre  dressing  (Fig.  265)  is  espe- 
cially  useful  in  the  field.  Prepare  three  strips  of  plaster,  each  three 
or  four  inches  wide  and  long  enough  to  go  one  and  one-half  times 
around  the  body.  Encircle  the  upper  arm  just  above  the  middle 
with  a  strip  of  bandage  wider  than  the  plaster ;  place  a  folded  towel 


ADHESIVE  PLASTER,  STRAPS  AND  STRAPPING    487 

in  the  axilla,  and  a  couple  of  layers  of  gauze  sprinkled  with  talcum 
wherever  the  skin  surfaces  would  come  in  contact.  Pin  a  loop  of 
one  of  the  plaster  strips,  sticky  side  out,  around  the  upper  arm  over 
the  bandage;  then,  while  an  assistant  holds  the  shoulders  back, 
carry  the  other  end  of  the  strip  across  the  back,  under  the  sound 
axilla,  and  over  the  front  of  the  cheM  back  to  the  starting  point. 
Now  place  the  hand  of  the  injured  side  on  the  sound  shoulder;  take 


Fig.   264. —  Strapping  the  Chest  for  Fractured  Ribs. 


the  second  strip  and,  starting  at  the  back' of  the  sound  shoulder, 
carry  it  obliquely  across  the  back,  under  the  elbow  of  the  injured 
side,  supporting  it,  and  up  over  the  the  injured  forearm  and  hand  to 
the  starting  point. 

The  third  strip  is  carried  circularly  around  the  body  holding  the 
arm  to  the  side. 

Where  the  second  strip  crosses  the  elbow  a  slit  should  be  made 
in  the  strip  to  secure  the  elbow,  which  must  here  be  protected  from 
cutting  by  the  edges  of  the  plaster  with  a  little  cotton  batting.  Over 
the  whole  a  Velpeau  bandage  may  be  applied. 


488 


MINOR  SURGERY 


Strapping  a  sprained  ankle  has  already  been  fully  described, 
page  90. 

A  swollen  testicle  after  the  acute  inflammation  has  subsided  is 
best  treated  by  strapping.  The  straps  should  be  a  half -inch  wide 
and  ten  or  twelve  inches  long;  the  operator  isolates  the  affected 
testicle  by  encircling  its  upper  part  with  the  thumb  and  index  fingers 


JlA 


Fig.    263. — Sayre's    Strapping   for    Fracture  Fig.  2t(>. —  Strapping  the  Testicle, 

of  Collar-bone.     Back  view. 

of  the  left  hand,  and  replacing  the  encircling  fingers  with  a  strap 
of  plaster.  He  then  covers  the  testicle  with  a  series  of  recurrent 
strips,  and  reenforces  the  latter  by  circular  strips  (Fig.  266). 

To  bring  the  edges  of  a  wound  together  in  the  absence  of  sutures, 
straps  of  plaster  one-fourth  to  one-half  an  inch  wide  may  be  used. 
As  the  plaster  is  not  aseptic  the  wound  itself  must  be  protected 
from  contact  with  the  plaster  by  a  narrow  strip  of  sterile  gauze. 

To  remove  plaster  straps  from  a  wound,  both  ends  of  the  strap 
must  be  detached  simultaneously  so  as  not  to  tear  apart  the  edges 
of  the  wound. 

When  a  good  deal  of  plaster  has  to  be  removed,  especially  if 
the  part  is  hairy,  a  little  ether  or  alcohol  should  be  dropped  under 
the  edges  of  the  plaster  as  it  is  raised;  this  will  cause  It  to  come 
away  without  any  pulling.  Any  remaining  plaster  may  be  washed 
off  with  ether  or  alcohol,  and  the  skin  then  dusted  with  talcum. 


INDEX 


Abduction,  49 
Abscesses,  47^ 
Acacia,  290 
Acetabulum,  42 
Acetanilid,  291 
Acid,  acetic,  291 

boric,  291 

citric,  291 

gallic,  291 

hydrochloric,  291 

hydrocyanic,  291 

nitric,  291 

oxalic,  291 

phosphoric,  292 

salicylic,  292 

sulphuric,  292 
aromatic,  292 

tannic,  292 

tartaric,  292 
Acids,  mineral,  287 

organic,  287 
Active  principles,  287 
Acupuncture,  478 
Adeps  benzoatus,  292 
Adrenalin  chloride,  292 
Admission  of  patients,  10 
Advance  group,  28 

medical  supply  depot,  31 
Administrative  zones,  12 
Adduction,  49 
^des  calopus,  356 
Aids  in  horsemanship,  381 
Aid  stations,  22 
Alcohol,  293 

wood,  293 

bath,  161 
Alimentary  principles,  62 

canal,  63 
Albuminates,  62 
Alcoholism,  128 
Alkalies,  288 
Alkaloids,  287 


Aloes,  293 
Alum,  293 
Ambulances,  417 
Ambulance  companies,  426 
Ammonia  water.  294 

aromatic  spirits,  294 

bromide,  294 

carbonate,  294 

chloride,  294 

nitrate,  294 
Anaesthesia,  467 

local,  467,  470 
Anaesthetics,  288 
Antitoxin,  diptheria,  477 
Ankle  joint,  42 
Anatomical  neck,  44 
Anthrax,  95 
Antipyrin,  294 
Antitoxins,  252 
Antidotes,   137,  288 
Anthelmintics,  288 
Anodynes,  288 
Antipyretics,  288 
Antiseptics,  288 
Astringents,  288 
Apparatus,   compressed   air,   234 

electric,  234 

restraint,  234 
•steam  sterilizing,  236 

infusion,  236 

blood  pressure,  238 
Apomorphine,  294 
Apples,  baked,  279 
Apothecaries*  weight,  324 
Aquae,  318 
Argyrol,  295 
Arsenic,  295 
Arachnoid,  55 
Arteries,  74 
Army  regulations,  413 
Artificial  limbs,  425 

respiration,   130 

(489) 


490 


INDEX 


Asafetida,  295 
Aspidium,  295 
Aspirin,  295 
Astragalus,  42 
Aseptic,  243 
Atomizer,  hand,  208 
Autoclave,  245 
Atropine  sulphate,  295 
Avoirdupois  weight,  323 

Bacon,  fried,  283 
Balsam  tolu,  310 
Baking  food,  268 
Baker,   161 
Bandaging,  185 

rules  for,  189 
Bandage,  plaster,  198 

roller,  188 

Scudder,  194 
.     tailed,  197 

triangular,    185 

Velpeau,  193 
Bacteria,  200,  242 
Bacilli,  242 

Ball  and  socket  joint,  41 
Base  group,  28 

hospital,  29 

medical  supply  depot,  30 
Baths,  alcohol,  161 

Brandt,  160 

electric  light,  162 

hot  air  and  steam,  158 

local,  162 

sedative,  158 

sponge,   157 
Batteries,  electric,  483 
Bearer  drill,  428 
Bed-bugs,  145 
Beds,  fracture,  154 

operative,  153 
Bed-sores,  155 
Beef  broth,  274 

juice,  273 

scraped,  280 

steak,  broiled,  280 

tea,  274 


Belladonna  extract,  296 

plaster,  296 
Belt  web,  241 
Bismuth,  subgallate,  29J 

subnitrate,   296 
Bistoury,  208 
Biers'  cups,  172 
Bile,  (i-j 

Blanc  mange,  281 
Bladder,  urinarj',  86 
Blisters,   173 
Blood,  71 

specimens,  479 
Blue  mass,  302 

ointment,  302 
Boiling,   food,  267 
Boils,  474 
Bone,  2)7 
Bottle  drop,  238 
Bougie,  208,  319 

a  boule,  208 

filiform,  208 
Brain,  53 

Brass,  to  clean,  144 
Bread  making,  268 
Broiling,  268 
Broth,  chicken,  274 

clam,  27s 
Bronchi,  81 
Brown  mixture,  300 
Buchu,  fluidextract,  296 
Burns,  123 
Bridle,  to,  z-jj 

Caffein,  citrate,  296 

Calcium,    precipitated    phosphate    of, 

296 
Calomel,  301 
Callus,  no 
Camphor,  296 

and  opium  pills,  256 
Camps,  364 

concentration,    17 

hospitals,  17 

infirmaries,  23 
Cantharides,  plaster,  297 
Capsicum,  297 


INDEX 


491 


Carbuncle,  475 

Carbolic  acid,  305 

Cardamoni  composita  tirictura,  297 

Carminatives,  288 

Carpus,  44,  45 

Caries,  38 

Cartilage,  38 

Cascara  sagrada,  fluidextract  of,  307 

tablets,  307 
Case  operating,  238 

emergency,  240 
Cataplasma,  319 
Catheterization,   167,  481 
Catheter,  208 
Catlin,  208 
Caustic  holder,  208 
Cautery,  Paquelin,  173 
Cement,  46 
Cerata,  318 

rosini,  297 
Cerebellum,  55 

Cerebrospinal  meningitis,  254 
Cerebrum,  53 
Cesspools,  349 
Chalk,  prepared,  299 
Chafing,  366 
Chancroid,  255 
Chartae,  318 
Chartulae,  319 

Che3'ne   Stokes  respiration,   178 
Chicken,  minced,  280 

stewed,  280 
Chilblain,  125 
Chloral  hydrate,  297 
Chloroform,  297 

administration  of,  409 
Chocolate,  281 
Cholera,  254 
Chromic  acid,  297 
Chrysarobin,  297 
Chyle,  63 
Chyme,  67 

Cinchona,  compound  tincture  of,  297 
Clamps,  pile,  21a 

towel,  210 
Clap,  368 


Clavicle,  45 

fracture  of,  486 
Clean  floors,  144 

metals,  144 

porcelain,  144 
Clerical  work,  459 
Cocaine,   hydrochloride,  297 
Codeine  sulphate,  298 
Colchicum  seed,  fluidextract  of,  298 
Colodion,  298,  318 
Copaiba,  298 
Capillaries,  75 
Colation,  316 
Coffee,  273 
Cold  pack,  160 
Collars,  horse,  407 
Colles'  fracture,  44 
Collyrium,  319 
Colon,  65 

Color  blindness,  60 
Combat,  duties  in,  20 
Compounding,  334 
Compound  cathartic  pills,  306 
Compression  of  the  brain,   127 
Compresses,  cold,  171 
Concentration  camps,  17 
Concussion  of  the  brain,  126 
Condyles,  41,  44 
Conjunctiva,  59 
Connective  tissue,  50,  148 
Contagious,  200 

Contagious  diseases  in  hospital,  29 
Contusion,  90 
Convalescent  camps,  29 
Convolutions,  52 
Cooking,  266 
Cooler,  prostatic,  210 
Copper  arsenite,  299 
Cornea,  59 

Correspondence,   records,  465 
Cotton,  367 
Counter  irritants,  171 
Crematories,  352 
Cresol,  298 

compound  solution  of,  299,  303 
Creosote,  carbonate,  298 
Crystalline  lens,  59 


492 


INDEX 


Cubeb,  299 
Cups,  dry,  172 
Biers',  172 
Curette,  208 
Custard,  baked,  276 
Cuticle,  50 
Cutting  shears,  210 

Darnall  filter,  341 
Death,  signs  of,  151 
Decantation,  316 
Decoctions,  313,  318 
Dentine,  46 
Derma,  50 
Desiccation,  317 
Diagnosis  tags,  240,  255 
Diaphragm,  50 
Diaphoretics,  288 
Diets,  full  or  house,  263 

liquid,  263 

light,  263 

special,  263 

serving  of,  148 
Digitalin,  299 
Digitalis,  tincture  of,  299 
Diphtheria,  antitoxin,  477 
Director,  212 

Discipline,  instruction  in,  427 
Disease,  prevention  of,  355 
Disinfectants,  289 
Disinfection  of  the  hands,  249 

rooms,  206 

tents,  207 
Dislocations,  41,  103 
Dismount,  to,  380 
Dispensary  management,  435 
Dispensatory,  311 
Distillation,  316,  317 
Diuretics,  289 
Divulsor,  urethral,  212 
Douche,  eye,  166 

nasal,  166 

spinal,  166 
Drainage  of  w^ounds,  249 
Dressings,  dry,  245 

wet,  24s 

sterilizing,  246 
Drill,  bone,  212 


Driving,  393,  398 

four  in  hand,  401 
Drovi^ning,   134 
Duties  of  the  medical  department,  13 

noncommissioned   officers,    16 
Dura  mater,  57 
Dyspnoea,  178 
Dysentery,  254,  361 

Ear,  58 

Effects  of  patients,  431 

Egg  and  sherry,  273 

lemonade,  273 

nog,  272 

omelet,  275 

poached,  275 

soft  cooked,  275 
Electric  batteries,  483 

light  baths,  162 

shock,   127 
Elixirs,  318 
Emetics,  289 
Emplastra,  318 
Empyema,  478 
Emulsions,  318,  320 
Enamel,  6 
Enema,  319 

Endoscope,  urethral,  212 
Enlisted    personnel,    medical    depart- 
ment, classification  of,  3 

uniform  of,  6 
Epsom  salts,  303 
Epilepsy,  128 
Eruptive  fevers,  361 
Erythroc3^es,   71 
Erysipelas,  257 
Ergot,  fluidextract,  299 
Ergotine,  299 

Emetine,  hydrochloride,  299 
Essentia,  319 
Ether,  293 

administration  of,  468 

compound  spirits,  293 

spirits  of  nitrous,  293 
Ethyl  chloride,  293 
Eucaine,  299 
Eucalyptol,  299 
Evacuation  ambulance  company,  2$ 


INDEX 


493 


Evacuation  hospital,  33 
Expectorants,  289 
Extension,  50 
Extractca,  318 
Eye,  59 

douche,  166 

Fainting,  126 
Fats,  61 

Feeding,  385,  406 
Felon,  475 
Femur,  40,  41 
Fevers,  177 
Field  desk,  241 
P'ield  hospitals,  24,  426 
Fibula,  41 
Filtration,  316 
Flexion,  50 
Fluidextracts,  318 
Fomentation,   170 
Foot  powder,  300 
Foot  soreness,  365 
Formalin,  303 
Fowler's  solution,  306 
Foramen  magnum,  45 
Foreign  bodies,  eye,  119 

ear,  120 

nose,  120 

throat,  121 

skin,  121 
Formaldehyde,  201 

gas,  201 
Forceps,  bone  holding,  214 

bullet,  212 

dental,  212 

dissecting,  214 

dressing,  214 

ear,  214 

gouge,  216 

haemostatic,  216 

Liston's  bone,  216 

mouse  tooth,  216 

nasal,  214 

needle  holder,  216 

sequestrum,  218 

sterilizer,  214 

tenaculum,  228 

tongue,  216 


Fractures,  108 

clavicle,  486 

ribs,  486 
Freezing,  general,  124 

local,  125 
Frost  bite,  125 
Frontal  bone,  45 

sinuses,  45 
Fruit,  stewed,  278 
Frying,  268 
Fund,  hospital,  436 
Furuncle,  474 

Gag,  mouth,  218 

Gall-bladder,  66 

Garrison  and  field  service,  417 

Gastric  juice,  66 

Gauze  sponges,  246 

General  hospitals,  420 

Gentian  compound  tincture,  300 

Ginger,  fluidextract,  310 

Glenoid  cavity,  45 

Gloves,  rubber,  250 

Glycerin,  300 

Glycerites,  318 

Gonorrhea,  255 

Gram,  324 

Grilling,  268 

Grooming,  384 

Gruel,  farina,  271 

hard  bread,  272 

rice,  271 
Guaiac  ammoniated  tincture,  301 
Guaiacol  carbonate,  301 

Hamamelis  leaves,  fluidextract,  301 
Harness,  355,  410 

to  fit,  396 
Hearing,  60 
Heart,  75 
Head  mirror,  318 
Heat,  use  of  in  pharmacy,  311 

exhaustion,  123 
Heating,  hot  water,  346 

steam,  347 
Hemorrhage,  arterial,  97 

venous,  96 
Hernia,  482 


494 


INDEX 


Heroin  hydrochloride,  301 

Hinged  joints,  41 

Hitch,  to,  398 

Homatropine  hydrobromide,  301 

Hoffman's  anodyne,  293 

Horse,  care  of,  388 

equipment,  372 
Horsehair,  sutures,  251 
Hospital  buildings,  423 

clothing,  433 

Corps,  instruction  of,  427 

field,  426 

fund,  436 

general,  420 

matrons,  437 

services  of,  420,  430 

ships,  18 

trains,  17 
Hydrargyrum  chloridum  corrosivum 

301 
Hydrastis,  fluidextract,  302 
Hj'giene,  personal,  z^y 
Hypodermic  syringe,  use  of,  ISO 
Hypnotics,  289 
Hyoscine,  hydrobromide,  302 
Hyoscyamus,  extract,  302 

compound  pills,  302 

Ice  bag,  171 

for  hospitals,  437 

water,  coil,  171 
Icthyol,  302 
Ilium,  40 

Incompatibility,  335 
Infection  and  disinfection,  200 
Infected  property,  433 
Inferior  maxillary  bone,  46 
Inflammation,  92 
Inflator,  Politzer,  2l8 
Influenza,  256 
Infusions,  313,  318 

saline,  476 
Inhaler,  chloroform,  2l8 

ether,  218 
Innominate  bone,  40 
Insect  powder,  302 
Insignia  of  sanitary  personnel,  etc.,  14 


Instruction,  winter  course,  428 

in  the  field,  430 
Instruments  and  appliances,  218 

sterilizing,  246 

cleaning,  250 
Insolation,  122 
Intermediate  group,  28 
Intestine,  large,  65 

small,  65 
Iodine,  302 
Iodoform,  302 

gauze,  246 
Ipecac  and  opium  powder,  302 

fluidextract,  303 

powdered,  302 
Irrigation,  165 

of  the  bladder,  168 
Iron  and  quinine  citrate,  299 

compound  pills,  300 

dried  sulphate,  300 

reduced,  300 

soluble  phosphate,  300 

syrup  of  iodide,  300 

tincture  of  chloride,  299 
Ischium,  40 

Jelly,  coffee,  278 

wine,  278 
Joint,  40 
Junket,  211 

Kidneys,  85 

Knives,  amputating,  220 

tenotomy,  220 
Koumyss,  272 

Laboratories,  Department,  442 
Lachrymal  probes,  220 

styles,  220 
Lancet,  220 
Lanolin,  292 
Lard,  benzoated,  292 
LarjTix,  81 
Latin  words,  ZZ^ 
Laundry,  hospital,  438 
Lavage  tube,  rectum,  220 

stomach,  220 


INDEX 


495 


Lemonade,  272 
Leucocytes,  71 
Lice,  366 
Licorice,  extract,  300 

compound  mixture,  300 

compound  powder,   300 
Ligatures,  sterilizing,  247 
Liglitning  stroke,  127 
Ligaments,  41 
Lime,  296 

chlorinated,  296 
Linen,  367 
Liniments,  318 
Line  of  communication,  2"^ 
Liquors,  318 
Liquor  creosotis  compound,  303 

formaldehyde,  303 
Liver,  66 
Liter,  324 
Lithium  carbonate,  303 

effervescing  citrate,  303 
Lunar  caustic,  479 
Lymphatics,  68,  70 
Lycopodium,  303 
Lyster's  sterilizing  bag,  338 

Magnesium  carbonate,  302 

oxide,  303 

sulphate,  303 
Malaria,  254 

prevention  of,  254 
Malarial  fever,  355,  357 
Master   hospital    sergeants,    appoint- 
ment of,  3 
Materia  medica,  287 
Matrons,  hospital,  437 
Measles,  256 

Measures,  approximate,  285 
Mechanical  subdivision  of  drugs,  Z'^l 
Medical  attendance,  424,  43 1 

supplies,  425 
Medicines,  giving  of,  I49,  289 

dosage,  289 


Medulla  oblongata,  55 

Meninges,  55 

Menstruum,  312 

Menthol,  303 

Mercury  corrosive  chloride,  301 

mass,  302 

ointment,  302 

ointment  of  nitrate,  302 

oleate,  302 

salicylate,  302 

yellow  oxide,  301,  302 
Mesentery,  67 
Mess  management,  259,  433 
Metric  system,  324 
Metacarpal  bones,  45 
Metatarsal  bones,  42 
Milk,  albuminized,  270 

peptonized,  270 

porridge,  277 

punch,  270 

sterilized,  270 
Micrococci,  242 
Mineral  acids,  287 
Minor  surgery,  467,  472 
Mixtures,  318 
Mobilization  camps,  17 
Morphine  sulphate,  303 
Mosquitoes,  anopheles,  356 

aedes  calopus,  356 
culex,  356 
Mount,  to,  378,  381,  382 
Mucous  membranes,  50 
Mumps,  256 
Muscles,  48 

sterno-mastoid,  50 
biceps,  50 
Myrrh,  tincture,  304 

Naphthalene,  304 
Narcotics,  289 
Nasal  bones,  4S 
douche,  166 


496 


INDEX 


National  formulary,  31 1 

Necrosis,  40 

Needle,  aneurism,  220 

surgical,  220 
Neosalvarsan,  304,  477 
Neutral  principles,  287 
Nerves,  brachial  plexus,  56 

cranial,  58 

dorsal,  56 

lumbar,  56 

motor,  57 

sacral,  56 

sensory,  57 

phrenic,  56 
Normal  saline  solution,  248 

tablets,  304 
Nose-bleed,  96 
Nux  vomica,  tincture,  304 

Oatmeal  porridge,  276 
Objects    of   medical    department   ad- 
ministration, 12 
Occipital  bone,  45  ^ 

Oesophagus,  63 
Officer  of  the  day,  439 
Oil,  castor,  304 

cloves,  304 

cod  liver,  304 

cotton  seed,  304 

croton,  305 

gaultheria,  304 

orange  peel,  304 

peppermint,  304 

santol,  305 

theobroma,  305 

turpentine,  305 

wintergreen,  304 
Oils,  essential,  288 

fixed,  288 

volatile,  288 
Ointments,  322 
Olecranon,  44 
Oleoresine,  318 
Omentum,  65 
Operating  room,  245 
Operations,  minor,  472 

after  care,  244 


Opium,  compound  tincture  of,  305 

poisoning,   129 
Optic  nerve,  60 
Orangeade,  272 
Organic  acids,  287 
Organization  in  war,  15 

Pack  saddle  and  packing,  389 
Palate,  6s 
Pancreas,  66 
Pancreatic  juice,  67 
Pancreatin,  305 
Paraplegia,  58 
Parietal  bone,  45 
Patients'  effects,  431 

public  property,  432 
Patella,  41 
Pelvis,  40 
Pepper,  305 

Peptonizing  tablets,  305 
Periosteotome,  220 
Percolation,  313 
Periosteum,  40 
Peroxide  solution,  295 
Personal  hygiene,  367 
Personnel  of  the  sanitary  service,  13 
Petrolatum,  305 

liquid,  305 
Phalanges,  42 
Pharmacy,  287,  311 
Pharmacopoea,  34 
Phenacetin,  291 
Phenol,  305 
Phenolphthalein,  306 
Physostigmine  sulphate,  306 
Pia  mater,  55 
Picric  acid,  310 
Piles,  475 
Pills,  318,  321 
Pill,  carminative,  306 

cathartic  compound,  306 
Pilocarpine  h3^drochloride,  306 
Plague,  55 
Pleura,  82 
Plumbi  acetas,  306 
Pneumonia,  256 


INDEX 


497 


Podophyllum,  resin  of,  306 
Poisoned  wounds,  94 
Poisoning,  136 

arsenic,  139 

carbolic  acid,  138 

chloral,  139 

corrosive  sublimate,  139 

nitrate  of  silver,  139 

phosphorus,  135 

ptomaine,  138 

strychnine,  140 

wood  alcohol,  138 
Poison  oak,  140 
Porcelain,  to  clean,  144 
Pons,  55 

Portal  system,  80 
Position  of  the  trooper,  378,  382 
Potatoes,  baked,  279 

boiled,  279 

mashed,  279 

roasted,  279 
Potable  water,  337 
Potash  acetate,  306 

arsenite  solution,  306 

bicarbonate,  306 

bromide,  306 

chlorate,  307 

and  sodium  tartrate,  307 

hydroxide,  307 

iodide,  307 

permanganate,  307 
Potts'  fracture,  42 
Poultices,  169 
Precipitate,  316 

Preparation  for  operation,  243 
Probe,  220 
Pronation,  48 
Protargol,  307 
Property  infected,  433 

medical,  care  of,  452 
Prunus    Virginiana,   fluidextract,   307 
Pubis,  40 
Pupil,  59 

Pulmonary  circulation,  72 
Pulse,  177 
Pyaemia,  92,  243 
Pyrethrum,  302 
32 


Quinine   hydrochlorosulphate,   307 
sulphate,  307 

Radius,  44 
Rabies,  95 
Ration,  62 

emergency,  259 

field,  259 

Filipino,  261 

garrison,  259 

reserve,  259 

travel,  259 
Recipes,  240 
Records,  list  of,  464 

and  correspondence,  465 
Reflex  action,  57 

Register,  sick  and  wounded,  444,  455 
Reins,  380,  401 

holding,  400 
Report,  sick  and  wounded,  448,  453 
Reports  and  returns,  460 
Requisitions,  449 
Rest  station,  18,  30 
Retina,  59 
Retractor,  222 

Rhamni  Purshianae  fluidextract,  28 
Rhei  pulvis,  308 
Rhubarb  powder,  308 
Ribs,  42 

fractures  of,  486 
Rice,  boiled,  277 

pudding,  284 

steamed,  277 
Riding,  371 
Rigor  mortis,  49 
Roasting  meats,  268 
Rochelle  salt,  307 
Rotation,  49 

Rubber  goods,  sterilizing,  248 
Rules  for  hospitals,  7 

of  the  road,  405 
Rupture,  482 

Sacchari  lactis,  308 
Saddle,  to,  373 


498 


INDEX 


Saddle  blanket,  to  fold,  372 

to  put  on,  373 
Saline  infusions,  476 
Salivary  glands,  64 
Salol,  306 
Salophen,  308 

Sanitary  soldier,  instruction  of,  4 
Sanitary  squads,  29 

train,  24,  418 
Santonin,  308 
Sapo  mollis,  308 
Saw,  amputating,  222 

Hey's,  222 

metacarpal,  222 

plaster  of  paris,  222 
Sayre's  dressing,  486 
Scalpel,  222 
Scapula,  43 
Scales,  327 

Schleich's  method,  471 
Scissors,  224 
Sclerotic,  60    . 
Searcher,  stone,  226 
Sebaceous  glands,  50 
Septicaemia,  92 
Sepsis,  200,  293 

Sergeants,    medical    department,    ex- 
amination, S 

first  class,  appointment  of,  5 
Scrums,  252 
Serum,   antidiphtherium,  308 

antitetanicum,   308 

antimeningitidis,   308 
Service  of  hospitals,  420 

of  the  interior,  17 
Sewage,  349 
Sewers,  349 
Shock,  60,  126 
Sick-call,  424 
Sight,  59 
Silver  nitrate,  295 
Sinapis  emplastrum,  308 
Siphon,  use  of,  316 


Snake  bite,  94 

Sodium,  bicarbonate,  308 

bicarbonate  and  peppermint,  308 

borate,  308 

bromide,  308 

carbonate,  dried,  309 

fluoride.  309 

hyposulphite,  309 

phosphate,  dried,  309 

salicylate,  309 
Soft  soap,  308 
Solutions,  312 

percentage,  312 

saturated,  312 
Sound,  urethral,  224 
Soup,  making,  267 

canned,  275 

pea,  284 

tomato,  285 
Spanish  windlass,  98 
Special  senses,  58 
Specimens,  collection  of,  183 

blood,  479 

water,  342 
Specula,  224,  226 
Spinal  anaesthesia,  471 

canal,  39 

cord,  39,  57 

column,  89 

douche,  166 
Spinous  processes,  40 
Spirits,  318 

frumenti,  309 

nitroglycerine,  308 
Spleen,  66 
Splints,  III 
Splinters,  121 
Splint  bone,  45 
Sponge  holder,  224 
Spores,  243 
Spud  and  needle,  226 
Sprains,  44,  105 
Stable  duty,  384 

management,  387 


INDEX 


499 


Status  of  sanitary  personnel,   15 
Station  for  slightly  wounded,  125 
Sterilization,  200 
Sterilizer,  245 
Stethoscope,  228 
Sternum,  42 
Stirrup,  383 
Stomach,  64 

tube,  480 
Straps  and  strapping,  485 
Strophanthus,  tincture,  309 
Strychnine  sulphate,  309 
Stupe,  170 
Styptics,  289 
Sulci,  S3 
Sulphur,  disinfection  by,  204 

lotum,  309 
Sulphonal,  309 

Sulphocarbolate  of  zinc,  310 
Superior  maxillary  bone,  45 
Supinator,  44,  49, 
Suppositories,  318,  322 
Suprarenal  gland,  88 
Supplies,  medical,  425,  449 
Surgical  neck,  44 

rounds,  244 
Surgery,  minor,  467 
Sutures,  41,  473 

sterilizing,  247 
Sugar  of  lead,  306 

milk,  308 
Sunstroke,  122 
Symptoms,  179 
Synovial  membrane,  40 
Syphilis,  255,  368,  477 
Syringes,  226,  228 
Syrups,  318 
Syrup  of  hypophosphites,  compound, 

309 
Systemic  circulation,  72 

Tabellae,  318 

Talc,  310 

Tarsus,  42 

Tartar  emetic,  294  , 

Tea,  273 


Teeth,  bicuspid,  46 

canine,  46 

incisors,  46 

molars,  46 

permanent,  46 

pulp,  46 

temporary,  46 
Temporal  bone,  45 
Tenesmus,  181 
Terebene,  310 
Testicle,  swollen,  488 
Tetanus,  95 

Theatre  of  operations,  iS 
Therapeutics,  287 
Thermocautery,  Paquelin,  230 
Thermograph,  177 
Thermometer,  clinical,  176 
Thorax,  42 
Tymol,  310 

iodide,  310 
Tibia,  41 
Tinctures,  318 

Titles  of  medical  officers,  16 
Toast,  dry,  276 

milk,  273 
Tolu,  balsam,  310 
Tomatoes,  baked,  285 

stewed,  285 
Tongue  depressor,  230 
Tonsils,  63 

Tonsillitis,  follicular,  i.j6 
Tonsillotome,  230 
Toothache,  483 
Tourniquet,  232 
Trachea,  81 
Tracheotomy  tube,  232 
Traps,  349 
Trephine,  232 
Tricresol,  298 
Trional,  309 
Trinitrophenol,  310 
Trochanter,  41 
Trocar  and  canula,  232 
Troches,  318 
Truss,  232,  482 
Tuberculosis,  pulmonary,  256 
Turnings,  403 


500 


INDEX 


Typhoid  fever,  253,  355 
Typhus  fever,  257 

Ulcers,  475 

Ulna,  44 

Unbridle,  to,  Z17 

Unguenta,  318 

Unharness,  to,  396 

Unhitch,  to,  398 

Unsaddle,  to,  375 

Urea,  87 

Ureters,  86 

Urethra,  87 

Urethral  injections,  165 

Urine,  incontinence  of,  182 

retention  of,  181 

suppression  of,  181 
Uro tropin,  301 

Vaccination,  antismallpox,  361 

antityphoid,  252 
Vaccines,  252 
Valerian,  fluidextract,  310 
Vaporization,  316 
Vaseline,  305 
Veins,  pulmonary,  78 

systemic,  78 
Venereal  diseases,  368 
Ventilation,  84,  344 
Ventricles,  53 
Veronal,  310 


Vertebrae,  cervical,  39 

dorsal,  39 

lumbar,  39 
Vertebral  column,  39 
Vinum  Xericum,  310 

Ward,  367 
Water,  ZV 

examination  of,  442 

purification,  338 

taking  samples,  342 
Watering  animals,  386 
Wax,  yellow,  297 
Wells,  337 
Whey,  271 
Whip,  403 

Wild  cherry,  fluidextract,  307 
Winter  course  of  instruction,  428 
Wintergreen  oil,  303 
Witch  hazel,  301 
Wounds,  91 

contused,  474 

incised,  473 

infection  of,  257 

Yellov/  fever,  254,  360 

Zinc,  oxide,  310 

phenolsulphate,  310 

sulphate,  310 
Zone  of  the  advance,  28 


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